| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
25,839 |
11,880 |
$1.69M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
21,468 |
21,308 |
$1.37M |
| D0120 |
Periodic oral evaluation - established patient |
15,733 |
15,632 |
$966K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
7,676 |
4,107 |
$882K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16,343 |
8,263 |
$866K |
| D0210 |
Intraoral - complete series of radiographic images |
17,637 |
17,515 |
$822K |
| D1120 |
Prophylaxis - child |
17,101 |
16,986 |
$675K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
7,107 |
4,439 |
$554K |
| D4341 |
|
7,827 |
2,163 |
$543K |
| D1110 |
Prophylaxis - adult |
6,506 |
6,455 |
$541K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
1,112 |
790 |
$528K |
| D0230 |
Intraoral - periapical each additional radiographic image |
110,718 |
22,176 |
$477K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,032 |
932 |
$471K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,871 |
2,974 |
$390K |
| D1351 |
Sealant - per tooth |
13,456 |
3,493 |
$382K |
| D0274 |
Bitewings - four radiographic images |
16,324 |
16,217 |
$341K |
| D0350 |
|
31,628 |
12,489 |
$318K |
| D4910 |
|
3,960 |
3,935 |
$293K |
| D1208 |
Topical application of fluoride, excluding varnish |
22,407 |
22,243 |
$266K |
| D2740 |
Crown - porcelain/ceramic |
434 |
332 |
$206K |
| D9430 |
|
5,669 |
5,448 |
$179K |
| D4342 |
|
4,229 |
1,302 |
$177K |
| D2330 |
|
2,263 |
1,416 |
$172K |
| D3320 |
|
410 |
353 |
$148K |
| D0330 |
Panoramic radiographic image |
3,443 |
3,415 |
$99K |
| D0340 |
|
1,826 |
1,813 |
$90K |
| D7240 |
Removal of impacted tooth - completely bony |
310 |
146 |
$71K |
| D7230 |
|
360 |
202 |
$67K |
| D2954 |
|
593 |
447 |
$61K |
| D2331 |
|
650 |
430 |
$52K |
| D3221 |
|
757 |
684 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
3,976 |
3,919 |
$47K |
| D2332 |
|
353 |
228 |
$28K |
| D0272 |
Bitewings - two radiographic images |
2,142 |
2,125 |
$25K |
| D1206 |
Topical application of fluoride varnish |
1,465 |
1,462 |
$22K |
| D2394 |
|
187 |
156 |
$16K |
| D3310 |
|
42 |
27 |
$13K |
| D1320 |
|
890 |
886 |
$9K |
| D9110 |
|
106 |
91 |
$5K |
| D1999 |
|
332 |
316 |
$220.00 |
| D1310 |
|
370 |
369 |
$0.00 |
| D1330 |
|
366 |
365 |
$0.00 |
| D0431 |
|
45 |
45 |
$0.00 |