| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,114 |
3,427 |
$304K |
| D1110 |
Prophylaxis - adult |
4,980 |
4,651 |
$246K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,594 |
5,120 |
$202K |
| D1206 |
Topical application of fluoride varnish |
5,830 |
5,496 |
$107K |
| D0210 |
Intraoral - complete series of radiographic images |
3,878 |
3,567 |
$72K |
| D9999 |
Unspecified adjunctive procedure, by report |
734 |
696 |
$71K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,027 |
1,208 |
$68K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,502 |
734 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
1,626 |
1,599 |
$61K |
| D1120 |
Prophylaxis - child |
2,418 |
2,213 |
$57K |
| D1351 |
Sealant - per tooth |
3,259 |
715 |
$55K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
711 |
533 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
4,747 |
4,303 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,347 |
1,304 |
$13K |
| D0272 |
Bitewings - two radiographic images |
1,523 |
1,412 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,488 |
3,172 |
$10K |
| D0330 |
Panoramic radiographic image |
513 |
503 |
$7K |
| D2740 |
Crown - porcelain/ceramic |
13 |
13 |
$5K |
| D0999 |
Unspecified diagnostic procedure, by report |
84 |
84 |
$5K |
| D9110 |
|
540 |
448 |
$4K |
| D2332 |
|
51 |
32 |
$3K |
| D0170 |
|
330 |
316 |
$1K |
| D9430 |
|
105 |
97 |
$860.00 |
| D1999 |
|
104 |
95 |
$840.00 |
| D0140 |
Limited oral evaluation - problem focused |
263 |
246 |
$805.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
13 |
12 |
$515.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$472.00 |
| D2331 |
|
20 |
13 |
$385.00 |
| D1354 |
|
14 |
13 |
$24.00 |
| D1330 |
|
38 |
32 |
$0.00 |