| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,321 |
1,494 |
$403K |
| D1351 |
Sealant - per tooth |
7,162 |
1,140 |
$238K |
| D1110 |
Prophylaxis - adult |
4,192 |
4,081 |
$214K |
| D2750 |
|
413 |
238 |
$187K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,162 |
769 |
$178K |
| D1206 |
Topical application of fluoride varnish |
6,699 |
6,575 |
$165K |
| D1120 |
Prophylaxis - child |
3,762 |
3,677 |
$161K |
| D0120 |
Periodic oral evaluation - established patient |
5,347 |
5,214 |
$146K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,484 |
761 |
$144K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,777 |
2,710 |
$132K |
| D0274 |
Bitewings - four radiographic images |
4,592 |
4,467 |
$94K |
| D0330 |
Panoramic radiographic image |
2,039 |
2,005 |
$86K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
93 |
82 |
$65K |
| D0140 |
Limited oral evaluation - problem focused |
1,562 |
1,507 |
$57K |
| D0220 |
Intraoral - periapical first radiographic image |
6,159 |
5,932 |
$53K |
| D3320 |
|
73 |
54 |
$45K |
| D2950 |
|
511 |
283 |
$42K |
| D7140 |
Extraction, erupted tooth or exposed root |
454 |
259 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,248 |
4,977 |
$41K |
| D2740 |
Crown - porcelain/ceramic |
98 |
54 |
$38K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
306 |
79 |
$32K |
| D1330 |
|
3,952 |
3,871 |
$24K |
| D0272 |
Bitewings - two radiographic images |
820 |
810 |
$12K |
| D4341 |
|
81 |
25 |
$7K |
| D3110 |
|
129 |
99 |
$2K |