| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20,624 |
3,428 |
$1.08M |
| D7140 |
Extraction, erupted tooth or exposed root |
7,319 |
2,918 |
$449K |
| D1110 |
Prophylaxis - adult |
7,553 |
6,914 |
$271K |
| D0330 |
Panoramic radiographic image |
5,553 |
5,000 |
$262K |
| D0120 |
Periodic oral evaluation - established patient |
12,991 |
12,166 |
$226K |
| D1120 |
Prophylaxis - child |
10,727 |
9,940 |
$223K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,736 |
11,792 |
$201K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,546 |
5,818 |
$189K |
| D0140 |
Limited oral evaluation - problem focused |
6,008 |
5,175 |
$135K |
| D0274 |
Bitewings - four radiographic images |
6,662 |
6,148 |
$127K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,795 |
845 |
$108K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,152 |
2,819 |
$87K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,005 |
9,360 |
$66K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
469 |
256 |
$60K |
| D0272 |
Bitewings - two radiographic images |
5,826 |
5,461 |
$60K |
| D0220 |
Intraoral - periapical first radiographic image |
11,690 |
10,354 |
$59K |
| D1351 |
Sealant - per tooth |
2,444 |
605 |
$54K |
| D2140 |
|
1,204 |
196 |
$48K |
| D2335 |
|
421 |
239 |
$41K |
| D2330 |
|
693 |
159 |
$28K |
| D3310 |
|
58 |
40 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
280 |
158 |
$12K |
| D2161 |
|
106 |
87 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
108 |
70 |
$5K |
| D2332 |
|
76 |
49 |
$5K |
| D3320 |
|
17 |
14 |
$5K |
| D1510 |
|
19 |
12 |
$4K |
| D2331 |
|
61 |
29 |
$3K |
| D2394 |
|
54 |
37 |
$2K |
| D1320 |
|
82 |
78 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$720.00 |
| D3120 |
|
225 |
142 |
$0.00 |
| D1330 |
|
30 |
30 |
$0.00 |