| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17,180 |
9,331 |
$1.97M |
| D1351 |
Sealant - per tooth |
39,692 |
6,129 |
$1.20M |
| D1120 |
Prophylaxis - child |
24,834 |
24,819 |
$989K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
11,082 |
6,494 |
$975K |
| D7140 |
Extraction, erupted tooth or exposed root |
11,362 |
6,138 |
$824K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,976 |
3,568 |
$687K |
| D1110 |
Prophylaxis - adult |
14,072 |
14,048 |
$672K |
| D0120 |
Periodic oral evaluation - established patient |
24,203 |
24,190 |
$649K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
16,187 |
16,170 |
$647K |
| D1208 |
Topical application of fluoride, excluding varnish |
25,773 |
25,763 |
$596K |
| D0274 |
Bitewings - four radiographic images |
12,068 |
12,062 |
$395K |
| D0210 |
Intraoral - complete series of radiographic images |
6,374 |
6,341 |
$364K |
| D0220 |
Intraoral - periapical first radiographic image |
22,566 |
22,295 |
$347K |
| D0140 |
Limited oral evaluation - problem focused |
9,436 |
9,214 |
$342K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,639 |
1,097 |
$196K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,143 |
15,740 |
$159K |
| D0272 |
Bitewings - two radiographic images |
6,181 |
6,179 |
$143K |
| D2335 |
|
914 |
646 |
$127K |
| D2710 |
|
178 |
149 |
$110K |
| D2331 |
|
1,229 |
756 |
$107K |
| D2394 |
|
625 |
487 |
$102K |
| D4341 |
|
708 |
307 |
$100K |
| D2330 |
|
1,234 |
783 |
$93K |
| D2950 |
|
557 |
480 |
$93K |
| D2332 |
|
715 |
457 |
$78K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,846 |
1,846 |
$53K |
| D2740 |
Crown - porcelain/ceramic |
79 |
58 |
$53K |
| D1206 |
Topical application of fluoride varnish |
1,570 |
1,568 |
$43K |
| D3320 |
|
60 |
57 |
$30K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
276 |
234 |
$30K |
| D2940 |
|
284 |
233 |
$20K |
| D5110 |
|
25 |
25 |
$16K |
| D5214 |
|
18 |
18 |
$15K |
| D0270 |
|
1,150 |
1,142 |
$14K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
12 |
$7K |
| D4342 |
|
94 |
43 |
$7K |
| D3310 |
|
14 |
13 |
$6K |
| D1510 |
|
29 |
26 |
$5K |
| D2954 |
|
16 |
13 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
17 |
13 |
$1K |
| D1999 |
|
1,026 |
893 |
$0.00 |