| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,263 |
2,807 |
$811K |
| D1110 |
Prophylaxis - adult |
12,417 |
11,883 |
$716K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,507 |
1,929 |
$474K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,250 |
1,383 |
$444K |
| D1208 |
Topical application of fluoride, excluding varnish |
16,304 |
15,671 |
$359K |
| D2750 |
|
665 |
367 |
$302K |
| D0220 |
Intraoral - periapical first radiographic image |
20,790 |
18,595 |
$289K |
| D0120 |
Periodic oral evaluation - established patient |
9,824 |
9,397 |
$258K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,342 |
4,194 |
$247K |
| D0274 |
Bitewings - four radiographic images |
6,831 |
6,609 |
$217K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,593 |
12,854 |
$173K |
| D0330 |
Panoramic radiographic image |
2,679 |
2,521 |
$167K |
| D2332 |
|
1,199 |
340 |
$144K |
| D4341 |
|
1,221 |
386 |
$130K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,048 |
570 |
$127K |
| D9110 |
|
1,462 |
1,409 |
$85K |
| D2394 |
|
421 |
235 |
$68K |
| D2335 |
|
431 |
156 |
$64K |
| D9944 |
|
190 |
175 |
$60K |
| D0180 |
|
1,028 |
997 |
$59K |
| D2331 |
|
472 |
236 |
$46K |
| D1120 |
Prophylaxis - child |
1,126 |
1,117 |
$45K |
| D2330 |
|
412 |
231 |
$31K |
| D2954 |
|
405 |
253 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
533 |
490 |
$22K |
| D0350 |
|
350 |
309 |
$14K |
| D1351 |
Sealant - per tooth |
385 |
59 |
$14K |
| D0460 |
|
623 |
568 |
$13K |
| D5214 |
|
12 |
12 |
$12K |
| D7953 |
|
30 |
13 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
139 |
83 |
$11K |
| D7250 |
|
52 |
29 |
$11K |
| D4355 |
|
106 |
102 |
$10K |
| D0272 |
Bitewings - two radiographic images |
181 |
181 |
$6K |
| D9310 |
|
66 |
57 |
$5K |
| D9430 |
|
80 |
72 |
$4K |
| D3110 |
|
48 |
28 |
$2K |
| D4346 |
|
14 |
13 |
$1K |
| D8670 |
Periodic orthodontic treatment visit |
249 |
249 |
$0.00 |