| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,317 |
2,427 |
$454K |
| D7140 |
Extraction, erupted tooth or exposed root |
8,121 |
2,576 |
$394K |
| D1110 |
Prophylaxis - adult |
8,730 |
8,709 |
$320K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,666 |
1,955 |
$286K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,136 |
1,510 |
$247K |
| D5226 |
|
290 |
290 |
$239K |
| D0120 |
Periodic oral evaluation - established patient |
10,115 |
10,094 |
$223K |
| D5225 |
|
264 |
264 |
$211K |
| D0210 |
Intraoral - complete series of radiographic images |
5,151 |
4,892 |
$204K |
| D0140 |
Limited oral evaluation - problem focused |
6,978 |
6,932 |
$196K |
| D0274 |
Bitewings - four radiographic images |
5,478 |
5,458 |
$141K |
| D0220 |
Intraoral - periapical first radiographic image |
11,982 |
11,664 |
$131K |
| D2740 |
Crown - porcelain/ceramic |
172 |
91 |
$129K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,363 |
4,350 |
$127K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,324 |
9,411 |
$119K |
| D1120 |
Prophylaxis - child |
2,515 |
2,514 |
$103K |
| D2950 |
|
607 |
396 |
$101K |
| D4342 |
|
1,032 |
357 |
$96K |
| D5110 |
|
180 |
180 |
$95K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,006 |
666 |
$91K |
| D1206 |
Topical application of fluoride varnish |
3,484 |
3,477 |
$81K |
| D4341 |
|
507 |
199 |
$74K |
| D0330 |
Panoramic radiographic image |
1,541 |
1,536 |
$67K |
| D2394 |
|
259 |
209 |
$40K |
| D2335 |
|
216 |
129 |
$33K |
| D1351 |
Sealant - per tooth |
1,067 |
169 |
$33K |
| D4910 |
|
302 |
302 |
$27K |
| D2330 |
|
356 |
226 |
$25K |
| D2332 |
|
245 |
168 |
$24K |
| D5120 |
|
39 |
39 |
$17K |
| D0272 |
Bitewings - two radiographic images |
465 |
463 |
$10K |
| D4355 |
|
247 |
247 |
$8K |
| D5214 |
|
14 |
14 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$300.00 |