| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,083 |
2,315 |
$381K |
| D1110 |
Prophylaxis - adult |
4,943 |
4,791 |
$250K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,630 |
6,343 |
$238K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,081 |
970 |
$221K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,913 |
1,624 |
$182K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,015 |
7,752 |
$149K |
| D0330 |
Panoramic radiographic image |
3,278 |
3,146 |
$143K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,362 |
687 |
$112K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,876 |
552 |
$106K |
| D0274 |
Bitewings - four radiographic images |
7,056 |
6,784 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
2,937 |
2,879 |
$87K |
| D0220 |
Intraoral - periapical first radiographic image |
7,744 |
7,279 |
$67K |
| D0140 |
Limited oral evaluation - problem focused |
2,481 |
2,366 |
$67K |
| D4341 |
|
2,832 |
768 |
$65K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,154 |
5,382 |
$24K |
| D4346 |
|
242 |
233 |
$17K |
| D1999 |
|
1,425 |
1,049 |
$16K |
| D2331 |
|
144 |
90 |
$11K |
| D1120 |
Prophylaxis - child |
426 |
411 |
$9K |
| D1351 |
Sealant - per tooth |
302 |
67 |
$6K |
| D9630 |
|
124 |
118 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
139 |
136 |
$4K |
| D2335 |
|
18 |
12 |
$2K |
| D2330 |
|
37 |
24 |
$2K |
| D4910 |
|
40 |
38 |
$1K |
| D0272 |
Bitewings - two radiographic images |
40 |
37 |
$404.11 |
| D9430 |
|
20 |
15 |
$0.00 |