| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,297 |
5,061 |
$818K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,849 |
3,223 |
$584K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,978 |
2,590 |
$295K |
| D1110 |
Prophylaxis - adult |
8,123 |
7,549 |
$283K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,980 |
1,972 |
$233K |
| D0120 |
Periodic oral evaluation - established patient |
8,886 |
8,244 |
$213K |
| D0330 |
Panoramic radiographic image |
3,954 |
3,660 |
$204K |
| D0274 |
Bitewings - four radiographic images |
6,430 |
5,969 |
$190K |
| D2394 |
|
1,279 |
925 |
$183K |
| D0220 |
Intraoral - periapical first radiographic image |
12,744 |
11,251 |
$177K |
| D0140 |
Limited oral evaluation - problem focused |
4,845 |
4,228 |
$155K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,161 |
2,977 |
$126K |
| D4355 |
|
1,956 |
1,817 |
$121K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,672 |
8,087 |
$120K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,219 |
791 |
$118K |
| D2335 |
|
1,020 |
646 |
$109K |
| D2332 |
|
992 |
663 |
$86K |
| D4341 |
|
954 |
444 |
$81K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,368 |
3,311 |
$56K |
| D1120 |
Prophylaxis - child |
1,381 |
1,341 |
$37K |
| D2331 |
|
433 |
319 |
$31K |
| D2330 |
|
270 |
169 |
$16K |
| D0272 |
Bitewings - two radiographic images |
816 |
802 |
$15K |
| D5110 |
|
14 |
13 |
$8K |