| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,004 |
1,535 |
$230K |
| D2335 |
|
1,540 |
519 |
$145K |
| D1110 |
Prophylaxis - adult |
4,078 |
4,041 |
$135K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,785 |
852 |
$98K |
| D0330 |
Panoramic radiographic image |
2,053 |
2,044 |
$91K |
| D0120 |
Periodic oral evaluation - established patient |
4,893 |
4,849 |
$81K |
| D1351 |
Sealant - per tooth |
3,662 |
777 |
$75K |
| D2161 |
|
940 |
723 |
$69K |
| D0274 |
Bitewings - four radiographic images |
2,962 |
2,926 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,107 |
2,087 |
$54K |
| D2140 |
|
1,244 |
426 |
$49K |
| D1120 |
Prophylaxis - child |
2,245 |
2,227 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,860 |
2,842 |
$42K |
| D2394 |
|
421 |
304 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
1,348 |
1,238 |
$30K |
| D4341 |
|
143 |
37 |
$13K |
| D0272 |
Bitewings - two radiographic images |
945 |
936 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
145 |
62 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,637 |
1,538 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,066 |
419 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
76 |
63 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
48 |
39 |
$2K |
| D1330 |
|
29 |
29 |
$0.00 |