| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,744 |
3,744 |
$245K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,847 |
1,700 |
$190K |
| D0210 |
Intraoral - complete series of radiographic images |
3,059 |
3,059 |
$145K |
| D2740 |
Crown - porcelain/ceramic |
297 |
248 |
$141K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
950 |
485 |
$113K |
| D1110 |
Prophylaxis - adult |
1,079 |
1,078 |
$95K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,107 |
861 |
$88K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,531 |
936 |
$82K |
| D4341 |
|
1,078 |
457 |
$75K |
| D1120 |
Prophylaxis - child |
1,409 |
1,407 |
$70K |
| D1351 |
Sealant - per tooth |
1,802 |
412 |
$65K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
114 |
108 |
$52K |
| D0350 |
|
5,356 |
2,173 |
$51K |
| D1206 |
Topical application of fluoride varnish |
2,541 |
2,540 |
$42K |
| D2331 |
|
296 |
189 |
$23K |
| D0330 |
Panoramic radiographic image |
784 |
781 |
$23K |
| D3320 |
|
48 |
45 |
$18K |
| D9430 |
|
542 |
524 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
291 |
146 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
210 |
210 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,199 |
1,049 |
$9K |
| D2330 |
|
89 |
58 |
$7K |
| D4910 |
|
61 |
61 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
320 |
315 |
$4K |
| D0274 |
Bitewings - four radiographic images |
193 |
193 |
$4K |
| D9110 |
|
62 |
61 |
$3K |
| D2394 |
|
34 |
32 |
$3K |
| D3221 |
|
34 |
32 |
$2K |
| D2335 |
|
16 |
12 |
$2K |
| D2332 |
|
21 |
15 |
$2K |
| D4342 |
|
31 |
14 |
$1K |
| D0272 |
Bitewings - two radiographic images |
104 |
104 |
$1K |
| D1310 |
|
12 |
12 |
$552.00 |
| D0270 |
|
103 |
103 |
$500.00 |