| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,890 |
1,714 |
$147K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,543 |
920 |
$136K |
| D1110 |
Prophylaxis - adult |
3,208 |
3,060 |
$100K |
| D0120 |
Periodic oral evaluation - established patient |
4,368 |
4,216 |
$71K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,517 |
933 |
$69K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,069 |
731 |
$66K |
| D0140 |
Limited oral evaluation - problem focused |
2,928 |
2,757 |
$62K |
| D0274 |
Bitewings - four radiographic images |
2,700 |
2,578 |
$50K |
| D0330 |
Panoramic radiographic image |
1,090 |
1,022 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,926 |
2,835 |
$42K |
| D1120 |
Prophylaxis - child |
1,961 |
1,906 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,287 |
1,219 |
$32K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
56 |
55 |
$21K |
| D2335 |
|
175 |
94 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
3,313 |
3,088 |
$15K |
| D2931 |
|
96 |
75 |
$11K |
| D2394 |
|
131 |
107 |
$10K |
| D2331 |
|
161 |
96 |
$9K |
| D8030 |
|
111 |
107 |
$9K |
| D1351 |
Sealant - per tooth |
443 |
134 |
$9K |
| D0272 |
Bitewings - two radiographic images |
628 |
612 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,244 |
688 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
34 |
23 |
$2K |
| D2330 |
|
23 |
12 |
$819.36 |