| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,779 |
5,660 |
$866K |
| D2740 |
Crown - porcelain/ceramic |
1,091 |
853 |
$606K |
| D1110 |
Prophylaxis - adult |
9,509 |
9,455 |
$400K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,242 |
3,498 |
$390K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,825 |
2,183 |
$316K |
| D0120 |
Periodic oral evaluation - established patient |
9,718 |
9,691 |
$240K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,959 |
6,934 |
$229K |
| D0210 |
Intraoral - complete series of radiographic images |
4,713 |
4,669 |
$229K |
| D1120 |
Prophylaxis - child |
4,955 |
4,951 |
$203K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,792 |
1,882 |
$197K |
| D0140 |
Limited oral evaluation - problem focused |
5,669 |
5,509 |
$186K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
326 |
320 |
$166K |
| D2950 |
|
1,042 |
941 |
$144K |
| D0274 |
Bitewings - four radiographic images |
5,143 |
5,131 |
$136K |
| D0220 |
Intraoral - periapical first radiographic image |
7,992 |
7,761 |
$105K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,035 |
4,030 |
$96K |
| D4341 |
|
760 |
277 |
$94K |
| D3320 |
|
201 |
191 |
$81K |
| D1206 |
Topical application of fluoride varnish |
2,736 |
2,736 |
$77K |
| D1351 |
Sealant - per tooth |
1,583 |
274 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,702 |
4,639 |
$47K |
| D2332 |
|
460 |
334 |
$45K |
| D0330 |
Panoramic radiographic image |
819 |
814 |
$30K |
| D0272 |
Bitewings - two radiographic images |
1,445 |
1,439 |
$30K |
| D4910 |
|
297 |
297 |
$17K |
| D2790 |
|
25 |
25 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
88 |
64 |
$11K |
| D0270 |
|
1,032 |
1,024 |
$9K |
| D2331 |
|
98 |
83 |
$8K |
| D2335 |
|
65 |
52 |
$8K |
| D2330 |
|
71 |
54 |
$5K |
| D2394 |
|
30 |
25 |
$3K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
13 |
12 |
$2K |
| D9310 |
|
34 |
34 |
$1K |
| D0602 |
|
112 |
112 |
$450.00 |
| D0603 |
|
18 |
18 |
$35.00 |
| D0601 |
|
14 |
14 |
$10.00 |