| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,926 |
2,250 |
$417K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,031 |
1,380 |
$327K |
| D4355 |
|
3,396 |
3,247 |
$224K |
| D0330 |
Panoramic radiographic image |
3,832 |
3,652 |
$216K |
| D1110 |
Prophylaxis - adult |
5,028 |
4,950 |
$196K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,488 |
1,026 |
$194K |
| D0274 |
Bitewings - four radiographic images |
5,916 |
5,707 |
$188K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,374 |
4,153 |
$181K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,297 |
6,601 |
$159K |
| D0140 |
Limited oral evaluation - problem focused |
4,192 |
3,997 |
$146K |
| D0220 |
Intraoral - periapical first radiographic image |
9,260 |
8,763 |
$138K |
| D4341 |
|
1,359 |
544 |
$134K |
| D0120 |
Periodic oral evaluation - established patient |
4,893 |
4,849 |
$121K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,294 |
957 |
$105K |
| D1206 |
Topical application of fluoride varnish |
3,372 |
3,273 |
$53K |
| D4342 |
|
838 |
378 |
$48K |
| D2331 |
|
205 |
137 |
$17K |
| D2332 |
|
116 |
72 |
$11K |
| D2335 |
|
93 |
57 |
$11K |
| D2394 |
|
70 |
58 |
$11K |
| D2330 |
|
54 |
36 |
$4K |
| D1120 |
Prophylaxis - child |
112 |
112 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
49 |
29 |
$3K |
| D0272 |
Bitewings - two radiographic images |
70 |
66 |
$1K |
| D1351 |
Sealant - per tooth |
35 |
12 |
$926.59 |