| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,114 |
1,788 |
$163K |
| D2750 |
|
506 |
383 |
$136K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,777 |
3,629 |
$81K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,349 |
1,167 |
$75K |
| D0210 |
Intraoral - complete series of radiographic images |
2,422 |
2,314 |
$66K |
| D1110 |
Prophylaxis - adult |
3,022 |
2,894 |
$66K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,012 |
592 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
1,837 |
1,771 |
$42K |
| D1120 |
Prophylaxis - child |
1,736 |
1,673 |
$34K |
| D1351 |
Sealant - per tooth |
1,711 |
279 |
$22K |
| D4341 |
|
645 |
232 |
$20K |
| D2954 |
|
367 |
291 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,605 |
1,552 |
$15K |
| D0274 |
Bitewings - four radiographic images |
1,924 |
1,860 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
694 |
637 |
$14K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
44 |
42 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,595 |
2,308 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
2,769 |
2,651 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
274 |
164 |
$9K |
| D2331 |
|
227 |
142 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
143 |
99 |
$6K |
| D2330 |
|
203 |
105 |
$6K |
| D3320 |
|
17 |
15 |
$3K |
| D2332 |
|
39 |
31 |
$2K |
| D0272 |
Bitewings - two radiographic images |
349 |
336 |
$2K |
| D2335 |
|
22 |
14 |
$1K |
| D0270 |
|
232 |
216 |
$481.75 |
| D2950 |
|
19 |
12 |
$428.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$385.65 |
| D9986 |
|
163 |
150 |
$0.00 |
| D1330 |
|
334 |
317 |
$0.00 |