| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,341 |
2,228 |
$270K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,029 |
1,087 |
$184K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,924 |
1,469 |
$170K |
| D1110 |
Prophylaxis - adult |
4,381 |
4,256 |
$164K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,116 |
1,374 |
$157K |
| D0210 |
Intraoral - complete series of radiographic images |
2,874 |
2,405 |
$152K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,492 |
4,382 |
$129K |
| D2740 |
Crown - porcelain/ceramic |
115 |
94 |
$92K |
| D4342 |
|
1,162 |
315 |
$78K |
| D0330 |
Panoramic radiographic image |
1,621 |
1,573 |
$75K |
| D0274 |
Bitewings - four radiographic images |
3,192 |
3,074 |
$71K |
| D0140 |
Limited oral evaluation - problem focused |
2,552 |
2,332 |
$64K |
| D9944 |
|
330 |
308 |
$61K |
| D0120 |
Periodic oral evaluation - established patient |
2,879 |
2,794 |
$57K |
| D2394 |
|
574 |
413 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,697 |
3,005 |
$39K |
| D9945 |
|
72 |
68 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
4,263 |
4,009 |
$24K |
| D1120 |
Prophylaxis - child |
965 |
941 |
$21K |
| D2335 |
|
201 |
95 |
$19K |
| D4341 |
|
309 |
58 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
856 |
841 |
$16K |
| D2331 |
|
212 |
124 |
$15K |
| D3310 |
|
56 |
27 |
$14K |
| D2330 |
|
207 |
116 |
$12K |
| D0470 |
|
429 |
404 |
$11K |
| D1320 |
|
528 |
517 |
$10K |
| D1206 |
Topical application of fluoride varnish |
623 |
599 |
$9K |
| D2161 |
|
108 |
57 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
125 |
58 |
$7K |
| D5213 |
|
12 |
12 |
$6K |
| D2160 |
|
88 |
49 |
$6K |
| D2332 |
|
60 |
40 |
$4K |
| D3320 |
|
14 |
12 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
51 |
31 |
$3K |
| D0272 |
Bitewings - two radiographic images |
203 |
197 |
$2K |
| D2140 |
|
50 |
29 |
$2K |
| D1351 |
Sealant - per tooth |
67 |
13 |
$1K |
| D9239 |
|
12 |
12 |
$840.00 |
| D0180 |
|
22 |
20 |
$342.55 |
| D1354 |
|
53 |
49 |
$0.00 |
| D1999 |
|
364 |
313 |
$0.00 |