| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
20,886 |
6,063 |
$1.27M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
13,906 |
4,491 |
$703K |
| D7140 |
Extraction, erupted tooth or exposed root |
8,261 |
2,508 |
$489K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
5,775 |
3,210 |
$439K |
| D1110 |
Prophylaxis - adult |
8,484 |
7,977 |
$318K |
| D2335 |
|
3,071 |
1,503 |
$298K |
| D0210 |
Intraoral - complete series of radiographic images |
3,276 |
3,061 |
$223K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,113 |
5,764 |
$172K |
| D2330 |
|
2,970 |
1,457 |
$160K |
| D2332 |
|
2,273 |
1,162 |
$141K |
| D0120 |
Periodic oral evaluation - established patient |
5,023 |
4,702 |
$97K |
| D0330 |
Panoramic radiographic image |
2,017 |
1,925 |
$94K |
| D2394 |
|
689 |
499 |
$67K |
| D0274 |
Bitewings - four radiographic images |
3,039 |
2,821 |
$67K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
945 |
253 |
$51K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,654 |
2,539 |
$45K |
| D1120 |
Prophylaxis - child |
1,767 |
1,664 |
$39K |
| D1351 |
Sealant - per tooth |
1,337 |
454 |
$35K |
| D3320 |
|
125 |
95 |
$35K |
| D2140 |
|
622 |
200 |
$25K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
378 |
201 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
473 |
439 |
$13K |
| D2331 |
|
211 |
141 |
$11K |
| D4341 |
|
131 |
47 |
$11K |
| D2160 |
|
153 |
87 |
$10K |
| D5214 |
|
12 |
12 |
$6K |
| D5110 |
|
13 |
13 |
$5K |
| D5120 |
|
12 |
12 |
$5K |
| D1206 |
Topical application of fluoride varnish |
250 |
208 |
$4K |
| D7310 |
|
28 |
12 |
$3K |
| D0272 |
Bitewings - two radiographic images |
135 |
127 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
17 |
13 |
$84.39 |