| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,948 |
3,330 |
$1.02M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,868 |
2,089 |
$374K |
| D2740 |
Crown - porcelain/ceramic |
457 |
318 |
$328K |
| D1120 |
Prophylaxis - child |
6,722 |
6,722 |
$280K |
| D0140 |
Limited oral evaluation - problem focused |
5,364 |
5,319 |
$230K |
| D7111 |
|
3,083 |
1,821 |
$217K |
| D1206 |
Topical application of fluoride varnish |
7,677 |
7,676 |
$202K |
| D0120 |
Periodic oral evaluation - established patient |
6,989 |
6,988 |
$198K |
| D0330 |
Panoramic radiographic image |
2,638 |
2,638 |
$179K |
| D1351 |
Sealant - per tooth |
4,844 |
886 |
$151K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
985 |
719 |
$149K |
| D4341 |
|
946 |
423 |
$137K |
| D2335 |
|
851 |
509 |
$130K |
| D1110 |
Prophylaxis - adult |
2,429 |
2,426 |
$126K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,706 |
2,701 |
$114K |
| D0274 |
Bitewings - four radiographic images |
3,005 |
3,004 |
$106K |
| D2950 |
|
383 |
328 |
$65K |
| D4355 |
|
404 |
404 |
$44K |
| D0210 |
Intraoral - complete series of radiographic images |
576 |
574 |
$40K |
| D3110 |
|
982 |
625 |
$34K |
| D4342 |
|
399 |
138 |
$31K |
| D3320 |
|
60 |
51 |
$31K |
| D0272 |
Bitewings - two radiographic images |
1,224 |
1,223 |
$31K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
145 |
109 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,196 |
1,192 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
163 |
108 |
$15K |
| D4910 |
|
40 |
40 |
$4K |
| D2330 |
|
20 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
174 |
118 |
$2K |
| D0180 |
|
19 |
19 |
$851.24 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,359 |
1,232 |
$0.00 |
| D9986 |
|
64 |
64 |
$0.00 |