| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,963 |
1,932 |
$231K |
| D0210 |
Intraoral - complete series of radiographic images |
2,421 |
2,236 |
$148K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,036 |
1,159 |
$137K |
| D1110 |
Prophylaxis - adult |
3,375 |
3,271 |
$122K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,134 |
3,976 |
$117K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,769 |
1,040 |
$98K |
| D0330 |
Panoramic radiographic image |
1,682 |
1,634 |
$79K |
| D0140 |
Limited oral evaluation - problem focused |
3,293 |
3,004 |
$71K |
| D0274 |
Bitewings - four radiographic images |
3,094 |
3,018 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
2,629 |
2,568 |
$47K |
| D2394 |
|
431 |
294 |
$31K |
| D2335 |
|
337 |
151 |
$30K |
| D9243 |
|
555 |
134 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
499 |
161 |
$24K |
| D1120 |
Prophylaxis - child |
1,210 |
1,170 |
$24K |
| D7240 |
Removal of impacted tooth - completely bony |
112 |
49 |
$21K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
261 |
57 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,886 |
1,361 |
$19K |
| D9239 |
|
261 |
248 |
$17K |
| D0250 |
|
1,329 |
1,250 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
2,909 |
2,689 |
$15K |
| D1206 |
Topical application of fluoride varnish |
896 |
875 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
237 |
130 |
$13K |
| D9610 |
|
159 |
150 |
$13K |
| D9222 |
|
107 |
104 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
831 |
813 |
$12K |
| D2740 |
Crown - porcelain/ceramic |
13 |
12 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
180 |
86 |
$10K |
| D2160 |
|
105 |
63 |
$7K |
| D1351 |
Sealant - per tooth |
270 |
64 |
$6K |
| D0272 |
Bitewings - two radiographic images |
674 |
650 |
$6K |
| D2331 |
|
81 |
52 |
$5K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$5K |
| D2332 |
|
54 |
38 |
$4K |
| D2140 |
|
76 |
41 |
$3K |
| D2330 |
|
31 |
25 |
$1K |
| D9612 |
|
18 |
16 |
$809.81 |