| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,944 |
4,050 |
$822K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,664 |
3,192 |
$515K |
| D1351 |
Sealant - per tooth |
15,083 |
2,743 |
$443K |
| D1120 |
Prophylaxis - child |
7,067 |
7,064 |
$286K |
| D0120 |
Periodic oral evaluation - established patient |
9,449 |
9,443 |
$258K |
| D1110 |
Prophylaxis - adult |
4,218 |
4,216 |
$212K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,270 |
978 |
$175K |
| D0274 |
Bitewings - four radiographic images |
6,298 |
6,285 |
$175K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,124 |
7,123 |
$174K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,124 |
777 |
$97K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,352 |
2,349 |
$96K |
| D0210 |
Intraoral - complete series of radiographic images |
1,479 |
1,449 |
$84K |
| D0330 |
Panoramic radiographic image |
1,143 |
1,142 |
$65K |
| D2740 |
Crown - porcelain/ceramic |
143 |
126 |
$58K |
| D0140 |
Limited oral evaluation - problem focused |
1,487 |
1,458 |
$57K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
457 |
297 |
$54K |
| D1206 |
Topical application of fluoride varnish |
1,914 |
1,914 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
3,275 |
3,140 |
$50K |
| D2950 |
|
186 |
176 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,187 |
1,187 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,783 |
1,267 |
$14K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
43 |
37 |
$5K |
| D2332 |
|
15 |
12 |
$960.94 |
| D1999 |
|
39 |
33 |
$0.00 |