| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,107 |
1,043 |
$265K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,602 |
338 |
$209K |
| D2750 |
|
397 |
216 |
$192K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
989 |
540 |
$163K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,452 |
2,402 |
$131K |
| D1351 |
Sealant - per tooth |
3,481 |
738 |
$117K |
| D1110 |
Prophylaxis - adult |
1,621 |
1,597 |
$101K |
| D1206 |
Topical application of fluoride varnish |
3,946 |
3,865 |
$97K |
| D1120 |
Prophylaxis - child |
2,215 |
2,175 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
2,475 |
2,428 |
$73K |
| D0330 |
Panoramic radiographic image |
1,345 |
1,338 |
$61K |
| D0140 |
Limited oral evaluation - problem focused |
1,285 |
1,207 |
$58K |
| D0274 |
Bitewings - four radiographic images |
2,504 |
2,475 |
$58K |
| D0220 |
Intraoral - periapical first radiographic image |
5,627 |
5,321 |
$56K |
| D2740 |
Crown - porcelain/ceramic |
136 |
70 |
$54K |
| D3320 |
|
80 |
57 |
$52K |
| D2950 |
|
586 |
313 |
$50K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
526 |
318 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,267 |
4,159 |
$42K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
51 |
49 |
$38K |
| D4341 |
|
414 |
146 |
$37K |
| D3120 |
|
989 |
460 |
$35K |
| D0272 |
Bitewings - two radiographic images |
845 |
820 |
$13K |
| D1330 |
|
2,065 |
2,027 |
$13K |
| D2394 |
|
22 |
15 |
$4K |
| D4355 |
|
15 |
12 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
51 |
51 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$798.00 |
| D0460 |
|
31 |
29 |
$310.00 |