| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,124 |
1,796 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,582 |
2,521 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,897 |
1,127 |
$27K |
| D2750 |
|
249 |
167 |
$27K |
| D1110 |
Prophylaxis - adult |
2,268 |
2,200 |
$21K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,153 |
788 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
1,674 |
1,643 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
1,850 |
1,800 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,275 |
741 |
$19K |
| D1120 |
Prophylaxis - child |
1,260 |
1,218 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
757 |
705 |
$6K |
| D2954 |
|
266 |
191 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,235 |
1,197 |
$5K |
| D0274 |
Bitewings - four radiographic images |
1,181 |
1,135 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
2,396 |
2,306 |
$4K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
45 |
25 |
$3K |
| D4341 |
|
156 |
77 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,200 |
1,839 |
$3K |
| D3320 |
|
19 |
13 |
$2K |
| D1351 |
Sealant - per tooth |
303 |
87 |
$2K |
| D0272 |
Bitewings - two radiographic images |
598 |
571 |
$1K |
| D2331 |
|
37 |
30 |
$648.00 |
| D0330 |
Panoramic radiographic image |
75 |
66 |
$594.00 |
| D0270 |
|
112 |
104 |
$147.00 |
| D9986 |
|
88 |
86 |
$0.00 |
| D1330 |
|
200 |
186 |
$0.00 |
| D3120 |
|
16 |
12 |
$0.00 |