| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
13,180 |
7,505 |
$1.31M |
| D1110 |
Prophylaxis - adult |
17,399 |
16,479 |
$619K |
| D0120 |
Periodic oral evaluation - established patient |
24,701 |
23,433 |
$609K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,944 |
4,866 |
$580K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,760 |
2,445 |
$448K |
| D0274 |
Bitewings - four radiographic images |
13,705 |
12,928 |
$399K |
| D0330 |
Panoramic radiographic image |
7,277 |
6,797 |
$390K |
| D0220 |
Intraoral - periapical first radiographic image |
27,154 |
25,364 |
$379K |
| D0230 |
Intraoral - periapical each additional radiographic image |
27,198 |
21,468 |
$327K |
| D1120 |
Prophylaxis - child |
10,562 |
9,995 |
$275K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,701 |
6,208 |
$270K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,586 |
12,903 |
$217K |
| D0140 |
Limited oral evaluation - problem focused |
4,600 |
4,226 |
$155K |
| D1351 |
Sealant - per tooth |
4,217 |
901 |
$119K |
| D0272 |
Bitewings - two radiographic images |
6,177 |
5,806 |
$106K |
| D1206 |
Topical application of fluoride varnish |
5,988 |
5,695 |
$94K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,076 |
575 |
$65K |
| D4341 |
|
731 |
284 |
$57K |
| D4355 |
|
765 |
733 |
$48K |
| D2332 |
|
576 |
293 |
$48K |
| D2394 |
|
274 |
146 |
$35K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
355 |
127 |
$33K |
| D2335 |
|
242 |
143 |
$28K |
| D2331 |
|
419 |
254 |
$27K |
| D2330 |
|
425 |
285 |
$25K |
| D4342 |
|
514 |
226 |
$24K |
| D5110 |
|
18 |
16 |
$9K |
| D4346 |
|
30 |
28 |
$968.61 |