| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2335 |
|
4,078 |
1,509 |
$493K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,041 |
3,172 |
$440K |
| D1110 |
Prophylaxis - adult |
9,461 |
9,449 |
$313K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,628 |
2,864 |
$285K |
| D0120 |
Periodic oral evaluation - established patient |
10,501 |
10,486 |
$200K |
| D0274 |
Bitewings - four radiographic images |
7,085 |
7,081 |
$131K |
| D1120 |
Prophylaxis - child |
2,676 |
2,670 |
$79K |
| D2332 |
|
979 |
460 |
$78K |
| D1351 |
Sealant - per tooth |
947 |
590 |
$76K |
| D0220 |
Intraoral - periapical first radiographic image |
7,814 |
7,665 |
$70K |
| D0330 |
Panoramic radiographic image |
3,080 |
3,075 |
$63K |
| D9944 |
|
637 |
635 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,348 |
2,347 |
$46K |
| D0210 |
Intraoral - complete series of radiographic images |
3,772 |
3,739 |
$43K |
| D2331 |
|
417 |
331 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,806 |
2,805 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,788 |
5,760 |
$27K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
410 |
106 |
$23K |
| D1206 |
Topical application of fluoride varnish |
709 |
706 |
$16K |
| D2394 |
|
203 |
99 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
1,178 |
1,133 |
$11K |
| D0272 |
Bitewings - two radiographic images |
563 |
563 |
$7K |
| D2330 |
|
77 |
71 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
57 |
51 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
18 |
14 |
$917.64 |