| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,868 |
2,191 |
$259K |
| D0120 |
Periodic oral evaluation - established patient |
3,511 |
3,489 |
$245K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,508 |
3,497 |
$232K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,458 |
1,643 |
$159K |
| D1120 |
Prophylaxis - child |
3,641 |
3,617 |
$158K |
| D0210 |
Intraoral - complete series of radiographic images |
2,599 |
2,586 |
$122K |
| D1110 |
Prophylaxis - adult |
1,342 |
1,334 |
$117K |
| D4910 |
|
1,404 |
1,391 |
$107K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22,515 |
4,189 |
$93K |
| D4341 |
|
1,303 |
363 |
$90K |
| D1351 |
Sealant - per tooth |
2,708 |
890 |
$85K |
| D0350 |
|
6,360 |
2,683 |
$61K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,724 |
3,705 |
$56K |
| D0274 |
Bitewings - four radiographic images |
2,441 |
2,429 |
$51K |
| D9430 |
|
1,568 |
1,505 |
$50K |
| D1310 |
|
1,034 |
1,030 |
$46K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
331 |
176 |
$39K |
| D2330 |
|
381 |
190 |
$29K |
| D9993 |
|
496 |
496 |
$28K |
| D1206 |
Topical application of fluoride varnish |
1,318 |
1,310 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,560 |
1,545 |
$18K |
| D2332 |
|
197 |
111 |
$16K |
| D2740 |
Crown - porcelain/ceramic |
30 |
27 |
$14K |
| D0601 |
|
793 |
789 |
$12K |
| D0272 |
Bitewings - two radiographic images |
672 |
666 |
$8K |
| D4342 |
|
130 |
39 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
37 |
27 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
14 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$983.00 |
| D2940 |
|
12 |
12 |
$630.00 |