| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
23,322 |
10,874 |
$1.56M |
| D0210 |
Intraoral - complete series of radiographic images |
21,345 |
17,422 |
$995K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
27,264 |
19,497 |
$845K |
| D1208 |
Topical application of fluoride, excluding varnish |
42,241 |
37,452 |
$803K |
| D1110 |
Prophylaxis - adult |
25,345 |
21,698 |
$791K |
| D0274 |
Bitewings - four radiographic images |
25,200 |
22,221 |
$749K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
2,178 |
917 |
$687K |
| D1120 |
Prophylaxis - child |
16,975 |
15,956 |
$684K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
12,218 |
5,795 |
$670K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
12,914 |
3,086 |
$660K |
| D0120 |
Periodic oral evaluation - established patient |
28,944 |
26,193 |
$657K |
| D0140 |
Limited oral evaluation - problem focused |
24,659 |
20,678 |
$638K |
| D7250 |
|
8,382 |
1,655 |
$601K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,891 |
2,817 |
$393K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,239 |
1,427 |
$280K |
| D0330 |
Panoramic radiographic image |
9,578 |
6,174 |
$272K |
| D0220 |
Intraoral - periapical first radiographic image |
24,211 |
20,695 |
$259K |
| D7240 |
Removal of impacted tooth - completely bony |
1,975 |
447 |
$236K |
| D8670 |
Periodic orthodontic treatment visit |
3,097 |
2,922 |
$216K |
| D2950 |
|
4,662 |
1,695 |
$154K |
| D1351 |
Sealant - per tooth |
4,313 |
947 |
$148K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,555 |
6,951 |
$139K |
| D7230 |
|
1,422 |
492 |
$137K |
| D3310 |
|
370 |
86 |
$83K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
253 |
174 |
$78K |
| D3320 |
|
217 |
88 |
$67K |
| D8660 |
|
3,149 |
1,888 |
$50K |
| D2331 |
|
559 |
302 |
$34K |
| D2954 |
|
590 |
221 |
$33K |
| D9310 |
|
1,212 |
1,014 |
$22K |
| D2332 |
|
250 |
132 |
$21K |
| D2791 |
|
48 |
37 |
$20K |
| D2394 |
|
261 |
100 |
$18K |
| D0270 |
|
1,174 |
979 |
$6K |
| D1206 |
Topical application of fluoride varnish |
287 |
254 |
$5K |
| D7220 |
|
59 |
30 |
$5K |
| D2330 |
|
115 |
54 |
$5K |
| D7241 |
|
77 |
29 |
$3K |
| D0272 |
Bitewings - two radiographic images |
64 |
61 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
23 |
16 |
$1K |
| D0601 |
|
78 |
55 |
$0.00 |
| D1330 |
|
140 |
108 |
$0.00 |
| D0470 |
|
61 |
57 |
$0.00 |
| D0602 |
|
72 |
65 |
$0.00 |
| D1310 |
|
113 |
85 |
$0.00 |
| D0431 |
|
57 |
47 |
$0.00 |
| D0340 |
|
71 |
60 |
$0.00 |
| D0350 |
|
128 |
124 |
$0.00 |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
12 |
12 |
$0.00 |