| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,803 |
2,379 |
$373K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,488 |
1,879 |
$221K |
| D1110 |
Prophylaxis - adult |
4,337 |
4,302 |
$164K |
| D1120 |
Prophylaxis - child |
5,313 |
5,281 |
$158K |
| D1206 |
Topical application of fluoride varnish |
8,047 |
7,991 |
$147K |
| D0120 |
Periodic oral evaluation - established patient |
8,064 |
8,003 |
$138K |
| D9630 |
|
5,798 |
5,742 |
$94K |
| D0274 |
Bitewings - four radiographic images |
3,107 |
3,087 |
$72K |
| D8670 |
Periodic orthodontic treatment visit |
145 |
142 |
$67K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
578 |
372 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,889 |
1,866 |
$49K |
| D1351 |
Sealant - per tooth |
1,302 |
437 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
1,631 |
1,548 |
$29K |
| D9920 |
|
397 |
378 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
378 |
238 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
450 |
439 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,973 |
1,908 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
114 |
54 |
$11K |
| D9310 |
|
125 |
125 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,400 |
1,302 |
$10K |
| D0330 |
Panoramic radiographic image |
269 |
268 |
$10K |
| D8660 |
|
76 |
76 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
299 |
299 |
$6K |
| D0272 |
Bitewings - two radiographic images |
315 |
315 |
$6K |
| D0340 |
|
51 |
51 |
$2K |
| D2330 |
|
18 |
13 |
$1K |
| D4910 |
|
40 |
40 |
$1K |
| D3120 |
|
44 |
27 |
$810.04 |
| D2740 |
Crown - porcelain/ceramic |
230 |
119 |
$0.00 |
| D2950 |
|
131 |
78 |
$0.00 |
| D4341 |
|
33 |
12 |
$0.00 |