| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,373 |
1,775 |
$336K |
| D9110 |
|
4,708 |
3,909 |
$203K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,584 |
1,144 |
$203K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,900 |
1,346 |
$201K |
| D0220 |
Intraoral - periapical first radiographic image |
13,181 |
11,261 |
$192K |
| D1110 |
Prophylaxis - adult |
4,617 |
4,404 |
$168K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,307 |
7,549 |
$167K |
| D0170 |
|
6,195 |
5,362 |
$163K |
| D0140 |
Limited oral evaluation - problem focused |
3,567 |
3,221 |
$118K |
| D4355 |
|
1,858 |
1,744 |
$115K |
| D0120 |
Periodic oral evaluation - established patient |
4,399 |
4,275 |
$104K |
| D0330 |
Panoramic radiographic image |
1,773 |
1,669 |
$99K |
| D0274 |
Bitewings - four radiographic images |
3,268 |
3,095 |
$99K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,439 |
1,327 |
$55K |
| D2394 |
|
312 |
250 |
$48K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
179 |
82 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
939 |
896 |
$15K |
| D2940 |
|
327 |
195 |
$12K |
| D2332 |
|
127 |
77 |
$11K |
| D1354 |
|
1,463 |
440 |
$10K |
| D7510 |
|
76 |
58 |
$7K |
| D1120 |
Prophylaxis - child |
245 |
231 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
90 |
52 |
$6K |
| D7450 |
|
28 |
27 |
$5K |
| D7250 |
|
21 |
13 |
$2K |
| D2335 |
|
17 |
12 |
$2K |
| D1206 |
Topical application of fluoride varnish |
105 |
101 |
$2K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$232.20 |
| D1355 |
|
41 |
25 |
$0.00 |
| D3110 |
|
270 |
219 |
$0.00 |