| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,596 |
4,985 |
$886K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,390 |
1,484 |
$558K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
5,610 |
3,042 |
$526K |
| D1351 |
Sealant - per tooth |
13,144 |
2,491 |
$363K |
| D0210 |
Intraoral - complete series of radiographic images |
7,536 |
5,916 |
$351K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,476 |
2,911 |
$330K |
| D1110 |
Prophylaxis - adult |
6,548 |
6,164 |
$329K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
505 |
428 |
$323K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,054 |
6,495 |
$270K |
| D2949 |
|
1,380 |
840 |
$265K |
| D2335 |
|
1,294 |
656 |
$205K |
| D0120 |
Periodic oral evaluation - established patient |
7,376 |
6,966 |
$173K |
| D1120 |
Prophylaxis - child |
4,409 |
4,123 |
$144K |
| D1206 |
Topical application of fluoride varnish |
6,357 |
5,987 |
$136K |
| D2394 |
|
1,118 |
784 |
$124K |
| D0140 |
Limited oral evaluation - problem focused |
3,435 |
3,170 |
$121K |
| D0274 |
Bitewings - four radiographic images |
3,490 |
3,258 |
$114K |
| D0330 |
Panoramic radiographic image |
2,296 |
2,104 |
$105K |
| D2332 |
|
772 |
492 |
$90K |
| D2331 |
|
744 |
472 |
$75K |
| D3310 |
|
152 |
76 |
$62K |
| D3320 |
|
108 |
78 |
$57K |
| D4342 |
|
782 |
191 |
$52K |
| D7111 |
|
630 |
428 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
4,107 |
3,522 |
$40K |
| D4341 |
|
274 |
68 |
$40K |
| D7250 |
|
180 |
91 |
$35K |
| D2330 |
|
301 |
173 |
$24K |
| D0272 |
Bitewings - two radiographic images |
974 |
916 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,769 |
1,606 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
26 |
25 |
$535.13 |
| D0145 |
Oral evaluation for a patient under three years of age |
16 |
16 |
$425.04 |
| D0240 |
|
26 |
12 |
$384.80 |