| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
10,951 |
10,805 |
$628K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,381 |
3,499 |
$475K |
| D0274 |
Bitewings - four radiographic images |
15,415 |
15,228 |
$447K |
| D1110 |
Prophylaxis - adult |
8,085 |
8,047 |
$342K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,109 |
1,595 |
$323K |
| D2721 |
|
315 |
219 |
$311K |
| D1206 |
Topical application of fluoride varnish |
14,313 |
14,220 |
$311K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,349 |
2,689 |
$297K |
| D0120 |
Periodic oral evaluation - established patient |
11,747 |
11,671 |
$295K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,407 |
7,344 |
$240K |
| D2332 |
|
2,348 |
1,325 |
$227K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,039 |
1,592 |
$224K |
| D1120 |
Prophylaxis - child |
6,024 |
5,995 |
$189K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,850 |
1,640 |
$175K |
| D0140 |
Limited oral evaluation - problem focused |
5,411 |
5,327 |
$166K |
| D2335 |
|
1,646 |
1,111 |
$161K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,910 |
1,004 |
$151K |
| D7111 |
|
1,385 |
727 |
$123K |
| D0220 |
Intraoral - periapical first radiographic image |
9,902 |
9,692 |
$119K |
| D1330 |
|
4,418 |
4,373 |
$119K |
| D1351 |
Sealant - per tooth |
4,556 |
669 |
$116K |
| D5226 |
|
90 |
85 |
$112K |
| D3320 |
|
340 |
288 |
$81K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,124 |
5,036 |
$81K |
| D2160 |
|
879 |
557 |
$78K |
| D2950 |
|
432 |
339 |
$76K |
| D2330 |
|
975 |
472 |
$69K |
| D0272 |
Bitewings - two radiographic images |
2,581 |
2,564 |
$68K |
| D2394 |
|
1,010 |
764 |
$62K |
| D3310 |
|
226 |
171 |
$60K |
| D2140 |
|
963 |
533 |
$57K |
| D5225 |
|
43 |
41 |
$51K |
| D6245 |
|
35 |
14 |
$50K |
| D2161 |
|
444 |
365 |
$48K |
| D6740 |
|
32 |
14 |
$46K |
| D7953 |
|
40 |
34 |
$33K |
| D4355 |
|
564 |
544 |
$13K |
| D7250 |
|
222 |
101 |
$3K |