| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,574 |
1,847 |
$306K |
| D0330 |
Panoramic radiographic image |
3,916 |
3,817 |
$305K |
| D1110 |
Prophylaxis - adult |
4,750 |
4,708 |
$279K |
| D0274 |
Bitewings - four radiographic images |
6,214 |
6,096 |
$250K |
| D0120 |
Periodic oral evaluation - established patient |
5,679 |
5,628 |
$212K |
| D1206 |
Topical application of fluoride varnish |
7,187 |
7,125 |
$211K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,783 |
8,574 |
$170K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,494 |
4,389 |
$169K |
| D0220 |
Intraoral - periapical first radiographic image |
9,665 |
9,398 |
$169K |
| D4341 |
|
803 |
318 |
$168K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,330 |
733 |
$132K |
| D1351 |
Sealant - per tooth |
3,746 |
1,141 |
$130K |
| D1120 |
Prophylaxis - child |
3,292 |
3,269 |
$127K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,660 |
993 |
$111K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
912 |
541 |
$86K |
| D1330 |
|
4,380 |
4,273 |
$64K |
| D7140 |
Extraction, erupted tooth or exposed root |
621 |
236 |
$62K |
| D0140 |
Limited oral evaluation - problem focused |
1,468 |
1,388 |
$55K |
| D0272 |
Bitewings - two radiographic images |
1,611 |
1,594 |
$52K |
| D2160 |
|
316 |
197 |
$42K |
| D2140 |
|
260 |
167 |
$22K |
| D2721 |
|
18 |
13 |
$19K |
| D2331 |
|
139 |
98 |
$17K |
| D7111 |
|
195 |
97 |
$16K |
| D4910 |
|
175 |
170 |
$15K |
| D2335 |
|
92 |
51 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
40 |
12 |
$6K |
| D2332 |
|
16 |
12 |
$2K |
| D0180 |
|
365 |
346 |
$2K |
| D0270 |
|
12 |
12 |
$83.67 |
| D9985 |
|
174 |
113 |
$68.05 |