| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,569 |
5,329 |
$741K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
12,009 |
5,301 |
$620K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,294 |
1,154 |
$315K |
| D1110 |
Prophylaxis - adult |
6,759 |
6,354 |
$309K |
| D0210 |
Intraoral - complete series of radiographic images |
4,318 |
3,712 |
$243K |
| D0120 |
Periodic oral evaluation - established patient |
9,914 |
9,312 |
$213K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,252 |
5,711 |
$213K |
| D0140 |
Limited oral evaluation - problem focused |
5,103 |
4,448 |
$164K |
| D1120 |
Prophylaxis - child |
5,320 |
5,041 |
$160K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,250 |
1,367 |
$159K |
| D0274 |
Bitewings - four radiographic images |
4,353 |
4,030 |
$139K |
| D1352 |
|
3,258 |
1,353 |
$113K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,699 |
5,377 |
$105K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,022 |
525 |
$76K |
| D4910 |
|
609 |
541 |
$55K |
| D1351 |
Sealant - per tooth |
2,604 |
677 |
$51K |
| D1206 |
Topical application of fluoride varnish |
2,162 |
2,004 |
$48K |
| D2332 |
|
658 |
345 |
$46K |
| D2394 |
|
652 |
402 |
$46K |
| D2330 |
|
659 |
355 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
4,191 |
3,242 |
$37K |
| D7250 |
|
165 |
81 |
$31K |
| D0272 |
Bitewings - two radiographic images |
1,394 |
1,273 |
$30K |
| D0330 |
Panoramic radiographic image |
525 |
483 |
$22K |
| D2335 |
|
303 |
146 |
$21K |
| D4342 |
|
492 |
153 |
$20K |
| D4346 |
|
106 |
96 |
$13K |
| D4341 |
|
93 |
25 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,392 |
846 |
$10K |
| D7111 |
|
112 |
54 |
$7K |
| D2331 |
|
75 |
48 |
$2K |
| D0270 |
|
27 |
12 |
$323.35 |
| D0145 |
Oral evaluation for a patient under three years of age |
14 |
12 |
$213.00 |
| D1999 |
|
28 |
26 |
$0.00 |
| D0350 |
|
56 |
45 |
$0.00 |