| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,371 |
2,849 |
$417K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,789 |
1,896 |
$237K |
| D4341 |
|
5,259 |
1,366 |
$223K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,799 |
3,767 |
$154K |
| D0140 |
Limited oral evaluation - problem focused |
4,616 |
4,562 |
$133K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,159 |
834 |
$120K |
| D0330 |
Panoramic radiographic image |
3,267 |
3,230 |
$118K |
| D0220 |
Intraoral - periapical first radiographic image |
10,839 |
10,417 |
$108K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
940 |
475 |
$87K |
| D0120 |
Periodic oral evaluation - established patient |
2,515 |
2,509 |
$85K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,816 |
3,796 |
$85K |
| D1110 |
Prophylaxis - adult |
1,155 |
1,145 |
$53K |
| D0274 |
Bitewings - four radiographic images |
4,352 |
4,324 |
$53K |
| D1206 |
Topical application of fluoride varnish |
1,683 |
1,679 |
$40K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
71 |
66 |
$37K |
| D1120 |
Prophylaxis - child |
1,652 |
1,645 |
$36K |
| D4910 |
|
366 |
364 |
$31K |
| D2335 |
|
193 |
84 |
$26K |
| D0270 |
|
3,089 |
3,059 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,068 |
6,740 |
$17K |
| D9110 |
|
209 |
202 |
$13K |
| D2332 |
|
85 |
54 |
$10K |
| D1351 |
Sealant - per tooth |
311 |
77 |
$8K |
| D0272 |
Bitewings - two radiographic images |
766 |
763 |
$7K |
| D7311 |
|
31 |
26 |
$4K |
| D2331 |
|
40 |
28 |
$4K |
| D4346 |
|
32 |
32 |
$2K |
| D0273 |
|
14 |
14 |
$201.96 |