| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,410 |
2,424 |
$810K |
| D1120 |
Prophylaxis - child |
10,958 |
10,714 |
$481K |
| D1206 |
Topical application of fluoride varnish |
17,996 |
17,622 |
$450K |
| D1351 |
Sealant - per tooth |
11,807 |
1,665 |
$405K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,569 |
2,004 |
$395K |
| D0120 |
Periodic oral evaluation - established patient |
12,833 |
12,589 |
$386K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,416 |
1,182 |
$381K |
| D1110 |
Prophylaxis - adult |
5,839 |
5,729 |
$364K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,068 |
1,403 |
$304K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
357 |
296 |
$267K |
| D0140 |
Limited oral evaluation - problem focused |
5,877 |
4,713 |
$266K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,033 |
3,919 |
$214K |
| D0330 |
Panoramic radiographic image |
3,835 |
3,753 |
$168K |
| D0274 |
Bitewings - four radiographic images |
5,100 |
4,990 |
$117K |
| D3320 |
|
170 |
137 |
$109K |
| D3310 |
|
155 |
82 |
$82K |
| D0220 |
Intraoral - periapical first radiographic image |
6,614 |
5,660 |
$66K |
| D4355 |
|
661 |
652 |
$65K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,331 |
2,275 |
$54K |
| D1330 |
|
7,877 |
7,689 |
$49K |
| D2332 |
|
302 |
152 |
$40K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,550 |
4,121 |
$40K |
| D7240 |
Removal of impacted tooth - completely bony |
116 |
41 |
$34K |
| D0272 |
Bitewings - two radiographic images |
2,158 |
2,111 |
$33K |
| D2330 |
|
215 |
121 |
$20K |
| D4341 |
|
100 |
25 |
$9K |
| D3120 |
|
145 |
84 |
$5K |
| D2394 |
|
30 |
24 |
$5K |
| D7220 |
|
19 |
12 |
$3K |
| D2331 |
|
18 |
13 |
$2K |