| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D8030 |
|
2,658 |
2,499 |
$215K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,196 |
1,866 |
$157K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,108 |
1,312 |
$128K |
| D0330 |
Panoramic radiographic image |
4,109 |
3,949 |
$125K |
| D1110 |
Prophylaxis - adult |
4,014 |
3,871 |
$124K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,381 |
3,226 |
$81K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,410 |
936 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
3,801 |
3,682 |
$59K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,343 |
3,219 |
$45K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
119 |
102 |
$39K |
| D8680 |
|
213 |
98 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
1,792 |
1,697 |
$35K |
| D1120 |
Prophylaxis - child |
1,955 |
1,910 |
$35K |
| D0274 |
Bitewings - four radiographic images |
3,600 |
3,443 |
$34K |
| D7140 |
Extraction, erupted tooth or exposed root |
466 |
223 |
$25K |
| D2332 |
|
267 |
152 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
4,883 |
4,288 |
$14K |
| D0340 |
|
632 |
605 |
$14K |
| D2394 |
|
194 |
169 |
$14K |
| D2335 |
|
146 |
89 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,060 |
2,754 |
$12K |
| D9243 |
|
312 |
127 |
$12K |
| D9610 |
|
143 |
131 |
$10K |
| D9239 |
|
141 |
131 |
$9K |
| D7240 |
Removal of impacted tooth - completely bony |
37 |
14 |
$7K |
| D0350 |
|
603 |
357 |
$6K |
| D0272 |
Bitewings - two radiographic images |
1,001 |
964 |
$6K |
| D1351 |
Sealant - per tooth |
197 |
49 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
45 |
25 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
12 |
$772.20 |
| D0470 |
|
14 |
14 |
$308.28 |
| D0270 |
|
68 |
67 |
$280.00 |
| D9219 |
|
49 |
42 |
$0.00 |