| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
11,842 |
5,905 |
$816K |
| D2954 |
|
4,194 |
2,818 |
$691K |
| D3310 |
|
2,052 |
1,338 |
$659K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,833 |
4,657 |
$654K |
| D3320 |
|
1,932 |
1,526 |
$616K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,648 |
3,372 |
$569K |
| D0330 |
Panoramic radiographic image |
15,468 |
15,463 |
$538K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,385 |
1,461 |
$502K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
15,200 |
15,197 |
$446K |
| D5110 |
|
683 |
682 |
$368K |
| D1110 |
Prophylaxis - adult |
6,546 |
6,546 |
$346K |
| D0120 |
Periodic oral evaluation - established patient |
11,841 |
11,836 |
$316K |
| D2330 |
|
4,608 |
2,583 |
$297K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,648 |
1,591 |
$267K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
295 |
243 |
$246K |
| D0274 |
Bitewings - four radiographic images |
8,253 |
8,249 |
$230K |
| D2394 |
|
1,394 |
1,163 |
$201K |
| D5120 |
|
366 |
366 |
$196K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,229 |
8,084 |
$166K |
| D1120 |
Prophylaxis - child |
3,174 |
3,174 |
$132K |
| D0210 |
Intraoral - complete series of radiographic images |
7,674 |
7,660 |
$111K |
| D0220 |
Intraoral - periapical first radiographic image |
4,721 |
4,700 |
$59K |
| D0272 |
Bitewings - two radiographic images |
3,235 |
3,235 |
$54K |
| D0140 |
Limited oral evaluation - problem focused |
3,733 |
3,709 |
$53K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,736 |
3,736 |
$52K |
| D1206 |
Topical application of fluoride varnish |
985 |
985 |
$29K |
| D1351 |
Sealant - per tooth |
338 |
174 |
$25K |
| D2332 |
|
115 |
99 |
$15K |
| D2140 |
|
160 |
59 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
90 |
46 |
$7K |
| D2335 |
|
27 |
26 |
$4K |
| D9995 |
|
135 |
126 |
$2K |
| D2160 |
|
16 |
13 |
$2K |
| D2331 |
|
12 |
12 |
$1K |