| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17,482 |
9,555 |
$1.26M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17,786 |
8,915 |
$1.09M |
| D0120 |
Periodic oral evaluation - established patient |
17,293 |
16,723 |
$449K |
| D0274 |
Bitewings - four radiographic images |
15,981 |
15,463 |
$434K |
| D1120 |
Prophylaxis - child |
9,633 |
9,464 |
$416K |
| D1110 |
Prophylaxis - adult |
11,880 |
11,204 |
$398K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,585 |
9,418 |
$261K |
| D0210 |
Intraoral - complete series of radiographic images |
4,285 |
4,035 |
$214K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,704 |
4,569 |
$185K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,795 |
1,337 |
$158K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
612 |
320 |
$157K |
| D2332 |
|
1,560 |
965 |
$151K |
| D8670 |
Periodic orthodontic treatment visit |
2,457 |
2,430 |
$91K |
| D0140 |
Limited oral evaluation - problem focused |
3,315 |
3,119 |
$90K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,848 |
710 |
$79K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,150 |
4,240 |
$60K |
| D7240 |
Removal of impacted tooth - completely bony |
321 |
56 |
$52K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
298 |
130 |
$33K |
| D9310 |
|
1,208 |
1,118 |
$26K |
| D2330 |
|
439 |
278 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
298 |
143 |
$26K |
| D2140 |
|
464 |
307 |
$21K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
369 |
237 |
$19K |
| D9222 |
|
125 |
117 |
$12K |
| D2791 |
|
37 |
24 |
$9K |
| D8660 |
|
445 |
343 |
$7K |
| D2335 |
|
42 |
27 |
$6K |
| D0270 |
|
1,175 |
1,115 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
474 |
438 |
$5K |
| D9243 |
|
15 |
13 |
$5K |
| D0330 |
Panoramic radiographic image |
85 |
83 |
$3K |
| D2954 |
|
29 |
12 |
$2K |
| D9239 |
|
14 |
13 |
$1K |
| D2950 |
|
50 |
26 |
$1K |
| D2999 |
|
25 |
13 |
$395.20 |