| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,965 |
4,383 |
$811K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,282 |
3,487 |
$581K |
| D1110 |
Prophylaxis - adult |
9,483 |
9,376 |
$368K |
| D0120 |
Periodic oral evaluation - established patient |
15,025 |
14,886 |
$353K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,604 |
1,952 |
$331K |
| D1120 |
Prophylaxis - child |
7,487 |
7,449 |
$300K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,619 |
8,568 |
$200K |
| D0210 |
Intraoral - complete series of radiographic images |
4,092 |
3,874 |
$199K |
| D0140 |
Limited oral evaluation - problem focused |
6,484 |
6,290 |
$199K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,671 |
6,986 |
$129K |
| D0220 |
Intraoral - periapical first radiographic image |
10,288 |
9,895 |
$123K |
| D0274 |
Bitewings - four radiographic images |
5,060 |
5,003 |
$122K |
| D4355 |
|
2,004 |
1,983 |
$106K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,967 |
2,920 |
$98K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,042 |
815 |
$84K |
| D2394 |
|
608 |
479 |
$63K |
| D9110 |
|
980 |
956 |
$59K |
| D1351 |
Sealant - per tooth |
2,046 |
504 |
$59K |
| D1354 |
|
3,268 |
3,215 |
$46K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
214 |
150 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,021 |
1,012 |
$21K |
| D2332 |
|
187 |
123 |
$17K |
| D2335 |
|
118 |
82 |
$14K |
| D1206 |
Topical application of fluoride varnish |
180 |
180 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
120 |
63 |
$5K |
| D2330 |
|
51 |
36 |
$4K |
| D7111 |
|
48 |
39 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
17 |
14 |
$3K |
| D0270 |
|
323 |
315 |
$3K |
| D2940 |
|
65 |
54 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
77 |
77 |
$2K |
| D2950 |
|
17 |
14 |
$1K |
| D1999 |
|
78 |
67 |
$0.00 |