| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,419 |
2,576 |
$190K |
| D1110 |
Prophylaxis - adult |
7,003 |
6,400 |
$163K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,762 |
6,288 |
$142K |
| D0210 |
Intraoral - complete series of radiographic images |
4,745 |
4,395 |
$134K |
| D2750 |
|
526 |
348 |
$127K |
| D0120 |
Periodic oral evaluation - established patient |
5,706 |
5,120 |
$118K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,196 |
1,715 |
$110K |
| D1120 |
Prophylaxis - child |
3,647 |
3,356 |
$85K |
| D0140 |
Limited oral evaluation - problem focused |
3,329 |
2,983 |
$76K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,138 |
513 |
$41K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
764 |
534 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,178 |
2,898 |
$35K |
| D0274 |
Bitewings - four radiographic images |
4,251 |
3,770 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
6,755 |
6,032 |
$24K |
| D4341 |
|
668 |
199 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,666 |
4,608 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
282 |
163 |
$12K |
| D0272 |
Bitewings - two radiographic images |
1,510 |
1,371 |
$7K |
| D2330 |
|
208 |
96 |
$6K |
| D2954 |
|
145 |
89 |
$6K |
| D2331 |
|
103 |
67 |
$4K |
| D3320 |
|
22 |
12 |
$4K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
20 |
12 |
$3K |
| D0330 |
Panoramic radiographic image |
202 |
193 |
$3K |
| D2950 |
|
63 |
56 |
$2K |
| D2332 |
|
23 |
13 |
$984.00 |
| D2335 |
|
19 |
12 |
$940.00 |
| D4910 |
|
30 |
24 |
$898.95 |
| D0270 |
|
72 |
64 |
$179.50 |
| D1330 |
|
810 |
497 |
$10.00 |
| D9986 |
|
176 |
169 |
$0.00 |