| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,110 |
5,326 |
$1.30M |
| D1110 |
Prophylaxis - adult |
14,883 |
14,600 |
$987K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,193 |
9,966 |
$686K |
| D1208 |
Topical application of fluoride, excluding varnish |
26,416 |
25,948 |
$621K |
| D0120 |
Periodic oral evaluation - established patient |
18,749 |
18,451 |
$586K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,531 |
2,771 |
$534K |
| D1120 |
Prophylaxis - child |
10,431 |
10,263 |
$461K |
| D0274 |
Bitewings - four radiographic images |
12,065 |
11,810 |
$455K |
| D0220 |
Intraoral - periapical first radiographic image |
24,380 |
23,525 |
$401K |
| D0140 |
Limited oral evaluation - problem focused |
7,934 |
7,667 |
$347K |
| D2750 |
|
624 |
451 |
$305K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20,151 |
17,417 |
$285K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,433 |
968 |
$232K |
| D0210 |
Intraoral - complete series of radiographic images |
2,449 |
2,405 |
$161K |
| D0350 |
|
2,057 |
2,024 |
$138K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,537 |
804 |
$129K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
927 |
568 |
$129K |
| D1351 |
Sealant - per tooth |
3,392 |
733 |
$125K |
| D4341 |
|
560 |
146 |
$73K |
| D0272 |
Bitewings - two radiographic images |
1,893 |
1,865 |
$68K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
94 |
90 |
$54K |
| D2954 |
|
265 |
210 |
$20K |
| D2332 |
|
82 |
56 |
$11K |
| D2950 |
|
53 |
39 |
$7K |
| D9110 |
|
80 |
79 |
$6K |
| D0270 |
|
168 |
167 |
$3K |
| D2335 |
|
17 |
13 |
$3K |