| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,909 |
4,300 |
$669K |
| D2332 |
|
5,906 |
2,335 |
$589K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
9,189 |
3,886 |
$547K |
| D2335 |
|
4,221 |
2,142 |
$535K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,506 |
2,061 |
$329K |
| D2394 |
|
2,330 |
1,309 |
$295K |
| D1110 |
Prophylaxis - adult |
7,166 |
6,979 |
$240K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,203 |
5,504 |
$235K |
| D2330 |
|
3,860 |
1,781 |
$221K |
| D0274 |
Bitewings - four radiographic images |
6,322 |
6,218 |
$191K |
| D1351 |
Sealant - per tooth |
5,201 |
1,293 |
$191K |
| D0210 |
Intraoral - complete series of radiographic images |
3,107 |
3,030 |
$185K |
| D2331 |
|
2,318 |
1,259 |
$174K |
| D1120 |
Prophylaxis - child |
4,008 |
3,926 |
$173K |
| D7250 |
|
2,617 |
674 |
$157K |
| D0120 |
Periodic oral evaluation - established patient |
5,635 |
5,507 |
$133K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,503 |
6,581 |
$130K |
| D1206 |
Topical application of fluoride varnish |
5,917 |
5,802 |
$130K |
| D0220 |
Intraoral - periapical first radiographic image |
8,282 |
8,030 |
$100K |
| D0330 |
Panoramic radiographic image |
3,811 |
3,067 |
$93K |
| D0140 |
Limited oral evaluation - problem focused |
3,075 |
2,793 |
$79K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,076 |
565 |
$78K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,427 |
537 |
$58K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,124 |
1,091 |
$22K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
334 |
186 |
$19K |
| D0272 |
Bitewings - two radiographic images |
829 |
810 |
$19K |
| D2140 |
|
303 |
172 |
$15K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
12 |
$6K |
| D2160 |
|
50 |
38 |
$4K |
| D2161 |
|
24 |
12 |
$2K |
| D0270 |
|
341 |
322 |
$2K |
| D1320 |
|
131 |
128 |
$435.63 |