| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,607 |
3,860 |
$513K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,626 |
2,348 |
$290K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,531 |
2,516 |
$271K |
| D1110 |
Prophylaxis - adult |
6,564 |
6,512 |
$248K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,544 |
1,864 |
$234K |
| D0140 |
Limited oral evaluation - problem focused |
8,753 |
8,373 |
$205K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,718 |
6,659 |
$192K |
| D0330 |
Panoramic radiographic image |
5,267 |
5,231 |
$177K |
| D0274 |
Bitewings - four radiographic images |
8,685 |
8,614 |
$176K |
| D0120 |
Periodic oral evaluation - established patient |
7,140 |
7,100 |
$157K |
| D0220 |
Intraoral - periapical first radiographic image |
15,018 |
14,343 |
$134K |
| D5214 |
|
138 |
133 |
$109K |
| D2740 |
Crown - porcelain/ceramic |
171 |
113 |
$109K |
| D0210 |
Intraoral - complete series of radiographic images |
2,704 |
2,350 |
$93K |
| D7250 |
|
1,178 |
536 |
$84K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,049 |
10,884 |
$81K |
| D1120 |
Prophylaxis - child |
1,840 |
1,837 |
$74K |
| D2331 |
|
1,115 |
649 |
$74K |
| D2332 |
|
700 |
433 |
$57K |
| D5213 |
|
57 |
55 |
$48K |
| D1206 |
Topical application of fluoride varnish |
2,409 |
2,397 |
$48K |
| D5110 |
|
84 |
82 |
$47K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
637 |
444 |
$44K |
| D2335 |
|
496 |
305 |
$43K |
| D2950 |
|
232 |
159 |
$38K |
| D1351 |
Sealant - per tooth |
1,288 |
321 |
$37K |
| D2394 |
|
376 |
296 |
$33K |
| D4341 |
|
128 |
51 |
$20K |
| D0272 |
Bitewings - two radiographic images |
794 |
792 |
$16K |
| D3320 |
|
28 |
25 |
$14K |
| D4342 |
|
121 |
49 |
$12K |
| D7310 |
|
115 |
63 |
$11K |
| D2330 |
|
140 |
92 |
$9K |
| D3310 |
|
21 |
12 |
$9K |
| D4910 |
|
94 |
94 |
$7K |
| D4355 |
|
44 |
43 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
63 |
62 |
$1K |
| D2940 |
|
87 |
79 |
$1K |
| D5410 |
|
24 |
24 |
$781.55 |
| D0270 |
|
47 |
47 |
$311.38 |
| D9110 |
|
43 |
41 |
$216.00 |
| D0431 |
|
42 |
39 |
$22.40 |
| D0602 |
|
53 |
53 |
$0.00 |
| D1330 |
|
91 |
90 |
$0.00 |
| D0460 |
|
25 |
20 |
$0.00 |
| D1999 |
|
168 |
145 |
$0.00 |