| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17,942 |
4,962 |
$1.08M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,245 |
4,296 |
$593K |
| D4342 |
|
4,255 |
1,601 |
$385K |
| D0210 |
Intraoral - complete series of radiographic images |
5,185 |
4,471 |
$268K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,143 |
1,118 |
$242K |
| D2330 |
|
3,610 |
1,606 |
$210K |
| D2740 |
Crown - porcelain/ceramic |
258 |
148 |
$209K |
| D2331 |
|
2,760 |
1,120 |
$204K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,399 |
6,129 |
$195K |
| D1110 |
Prophylaxis - adult |
4,195 |
4,047 |
$164K |
| D0330 |
Panoramic radiographic image |
3,327 |
3,201 |
$161K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,230 |
1,412 |
$161K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20,052 |
4,534 |
$126K |
| D0140 |
Limited oral evaluation - problem focused |
5,341 |
4,883 |
$126K |
| D0120 |
Periodic oral evaluation - established patient |
6,073 |
5,899 |
$125K |
| D0274 |
Bitewings - four radiographic images |
5,051 |
4,881 |
$122K |
| D4341 |
|
678 |
216 |
$107K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,269 |
366 |
$100K |
| D2335 |
|
1,019 |
521 |
$94K |
| D1120 |
Prophylaxis - child |
3,041 |
2,937 |
$70K |
| D1206 |
Topical application of fluoride varnish |
3,649 |
3,538 |
$66K |
| D2394 |
|
830 |
556 |
$62K |
| D9243 |
|
1,013 |
255 |
$47K |
| D2931 |
|
402 |
277 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
6,202 |
5,813 |
$39K |
| D7240 |
Removal of impacted tooth - completely bony |
196 |
104 |
$36K |
| D2332 |
|
423 |
277 |
$31K |
| D1351 |
Sealant - per tooth |
1,176 |
331 |
$25K |
| D3320 |
|
63 |
51 |
$25K |
| D9239 |
|
358 |
338 |
$24K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
369 |
177 |
$20K |
| D0250 |
|
1,529 |
1,441 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,416 |
1,378 |
$16K |
| D2140 |
|
334 |
142 |
$14K |
| D9610 |
|
155 |
140 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
797 |
763 |
$11K |
| D0180 |
|
411 |
395 |
$11K |
| D2160 |
|
113 |
66 |
$8K |
| D7310 |
|
55 |
28 |
$6K |
| D5110 |
|
13 |
12 |
$5K |
| D2161 |
|
46 |
34 |
$4K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
41 |
12 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
38 |
34 |
$2K |
| D4910 |
|
28 |
27 |
$2K |
| D9612 |
|
41 |
38 |
$2K |
| D9222 |
|
12 |
12 |
$2K |