| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,805 |
5,851 |
$715K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,713 |
9,681 |
$636K |
| D2740 |
Crown - porcelain/ceramic |
1,009 |
777 |
$478K |
| D1110 |
Prophylaxis - adult |
4,830 |
4,815 |
$420K |
| D0120 |
Periodic oral evaluation - established patient |
5,311 |
5,281 |
$396K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,336 |
4,160 |
$394K |
| D0210 |
Intraoral - complete series of radiographic images |
8,121 |
8,097 |
$384K |
| D1120 |
Prophylaxis - child |
5,953 |
5,923 |
$287K |
| D0350 |
|
23,340 |
8,658 |
$226K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,821 |
2,038 |
$221K |
| D1206 |
Topical application of fluoride varnish |
11,634 |
11,590 |
$187K |
| D1351 |
Sealant - per tooth |
4,130 |
984 |
$154K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,209 |
763 |
$141K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,461 |
991 |
$139K |
| D4341 |
|
1,965 |
540 |
$137K |
| D0274 |
Bitewings - four radiographic images |
4,776 |
4,751 |
$100K |
| D4910 |
|
1,246 |
1,240 |
$95K |
| D2330 |
|
1,102 |
634 |
$84K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,458 |
7,136 |
$73K |
| D9430 |
|
1,333 |
1,300 |
$42K |
| D0330 |
Panoramic radiographic image |
1,364 |
1,356 |
$40K |
| D2331 |
|
363 |
251 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
963 |
955 |
$11K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
24 |
24 |
$11K |
| D1310 |
|
193 |
193 |
$8K |
| D2394 |
|
65 |
52 |
$5K |
| D3310 |
|
16 |
12 |
$5K |
| D2332 |
|
56 |
40 |
$5K |
| D2335 |
|
19 |
14 |
$2K |
| D3221 |
|
15 |
15 |
$945.00 |
| D0272 |
Bitewings - two radiographic images |
68 |
68 |
$816.00 |
| D0270 |
|
49 |
49 |
$240.00 |