| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,830 |
1,287 |
$180K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,586 |
638 |
$103K |
| D1110 |
Prophylaxis - adult |
2,747 |
2,661 |
$102K |
| D0120 |
Periodic oral evaluation - established patient |
4,005 |
3,914 |
$99K |
| D0210 |
Intraoral - complete series of radiographic images |
1,549 |
1,498 |
$94K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
746 |
577 |
$87K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,167 |
4,077 |
$87K |
| D1120 |
Prophylaxis - child |
1,501 |
1,491 |
$65K |
| D2330 |
|
977 |
531 |
$55K |
| D0274 |
Bitewings - four radiographic images |
1,571 |
1,540 |
$53K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
464 |
296 |
$38K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
92 |
67 |
$35K |
| D1351 |
Sealant - per tooth |
687 |
198 |
$26K |
| D2950 |
|
262 |
207 |
$21K |
| D0330 |
Panoramic radiographic image |
265 |
265 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
364 |
355 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,151 |
1,119 |
$14K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
16 |
16 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
427 |
417 |
$13K |
| D3320 |
|
15 |
12 |
$10K |
| D2140 |
|
160 |
121 |
$9K |
| D2331 |
|
93 |
73 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
539 |
359 |
$6K |
| D2335 |
|
14 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
25 |
25 |
$773.44 |