| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,840 |
1,838 |
$162K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,368 |
857 |
$158K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,352 |
2,348 |
$154K |
| D2335 |
|
1,287 |
466 |
$151K |
| D4341 |
|
1,762 |
462 |
$123K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
775 |
441 |
$90K |
| D0210 |
Intraoral - complete series of radiographic images |
1,859 |
1,857 |
$89K |
| D2740 |
Crown - porcelain/ceramic |
164 |
98 |
$78K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
739 |
411 |
$59K |
| D0350 |
|
4,604 |
1,198 |
$43K |
| D4910 |
|
501 |
500 |
$38K |
| D9430 |
|
1,150 |
1,074 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
661 |
358 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,292 |
2,290 |
$34K |
| D2330 |
|
356 |
188 |
$28K |
| D1120 |
Prophylaxis - child |
444 |
444 |
$23K |
| D1351 |
Sealant - per tooth |
303 |
58 |
$11K |
| D4342 |
|
267 |
89 |
$11K |
| D0330 |
Panoramic radiographic image |
380 |
380 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,604 |
832 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
230 |
230 |
$9K |
| D0274 |
Bitewings - four radiographic images |
438 |
438 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
145 |
71 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
438 |
427 |
$5K |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$156.00 |