| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,521 |
5,582 |
$943K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
9,618 |
5,519 |
$731K |
| D0120 |
Periodic oral evaluation - established patient |
30,492 |
28,129 |
$713K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
5,324 |
2,763 |
$545K |
| D1110 |
Prophylaxis - adult |
14,082 |
13,069 |
$491K |
| D1120 |
Prophylaxis - child |
17,682 |
16,457 |
$446K |
| D0220 |
Intraoral - periapical first radiographic image |
29,121 |
26,702 |
$400K |
| D1208 |
Topical application of fluoride, excluding varnish |
24,496 |
22,798 |
$380K |
| D0140 |
Limited oral evaluation - problem focused |
8,941 |
8,203 |
$291K |
| D0230 |
Intraoral - periapical each additional radiographic image |
24,430 |
20,372 |
$289K |
| D0274 |
Bitewings - four radiographic images |
8,869 |
8,181 |
$254K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,833 |
4,443 |
$183K |
| D1351 |
Sealant - per tooth |
5,966 |
1,303 |
$152K |
| D0272 |
Bitewings - two radiographic images |
8,836 |
8,207 |
$148K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,239 |
1,267 |
$138K |
| D7311 |
|
864 |
559 |
$80K |
| D0210 |
Intraoral - complete series of radiographic images |
1,127 |
1,026 |
$70K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
525 |
381 |
$63K |
| D7250 |
|
573 |
255 |
$62K |
| D0330 |
Panoramic radiographic image |
1,455 |
1,353 |
$60K |
| D4355 |
|
823 |
761 |
$50K |
| D1206 |
Topical application of fluoride varnish |
1,301 |
1,113 |
$18K |
| D2330 |
|
195 |
123 |
$13K |
| D7240 |
Removal of impacted tooth - completely bony |
71 |
27 |
$12K |
| D2335 |
|
35 |
24 |
$4K |
| D4346 |
|
135 |
110 |
$4K |
| D4341 |
|
33 |
14 |
$3K |
| D2332 |
|
24 |
13 |
$2K |
| D2331 |
|
22 |
14 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
128 |
88 |
$1K |
| D1354 |
|
27 |
12 |
$203.50 |
| D0601 |
|
92 |
90 |
$0.00 |
| D0602 |
|
198 |
187 |
$0.00 |
| D0603 |
|
9,459 |
8,498 |
$0.00 |
| D9995 |
|
12 |
12 |
$0.00 |
| D4999 |
|
21 |
21 |
$0.00 |
| DR0BE |
|
243 |
229 |
$0.00 |
| D0191 |
|
835 |
746 |
$0.00 |