| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
24,201 |
6,520 |
$966K |
| D2750 |
|
3,321 |
2,420 |
$730K |
| D2335 |
|
7,972 |
2,219 |
$413K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,724 |
2,343 |
$205K |
| D1110 |
Prophylaxis - adult |
13,231 |
13,082 |
$182K |
| D0120 |
Periodic oral evaluation - established patient |
11,396 |
11,290 |
$149K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,634 |
2,213 |
$139K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
677 |
555 |
$127K |
| D0210 |
Intraoral - complete series of radiographic images |
5,546 |
5,481 |
$109K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,666 |
6,596 |
$104K |
| D0274 |
Bitewings - four radiographic images |
9,145 |
9,065 |
$62K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,820 |
1,100 |
$58K |
| D1120 |
Prophylaxis - child |
4,487 |
4,459 |
$56K |
| D2954 |
|
1,518 |
1,120 |
$55K |
| D2332 |
|
1,206 |
475 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
14,903 |
14,580 |
$46K |
| D0140 |
Limited oral evaluation - problem focused |
3,192 |
3,123 |
$40K |
| D2950 |
|
821 |
579 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,982 |
11,820 |
$29K |
| D1206 |
Topical application of fluoride varnish |
2,129 |
2,117 |
$26K |
| D2394 |
|
554 |
346 |
$24K |
| D1351 |
Sealant - per tooth |
2,738 |
416 |
$24K |
| D4341 |
|
746 |
229 |
$22K |
| D3320 |
|
99 |
79 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,605 |
1,588 |
$8K |
| D0272 |
Bitewings - two radiographic images |
1,274 |
1,255 |
$6K |
| D9110 |
|
481 |
473 |
$4K |
| D5630 |
|
35 |
24 |
$3K |
| D0180 |
|
150 |
150 |
$2K |
| D0270 |
|
525 |
519 |
$1K |
| D5761 |
|
12 |
12 |
$996.00 |
| D0330 |
Panoramic radiographic image |
25 |
25 |
$412.00 |