| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,647 |
1,483 |
$632K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,929 |
1,198 |
$521K |
| D2332 |
|
1,730 |
298 |
$273K |
| D8660 |
|
1,728 |
1,614 |
$242K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,378 |
605 |
$225K |
| D1110 |
Prophylaxis - adult |
3,733 |
3,565 |
$175K |
| D0274 |
Bitewings - four radiographic images |
3,376 |
3,191 |
$101K |
| D0120 |
Periodic oral evaluation - established patient |
3,782 |
3,687 |
$94K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,145 |
1,923 |
$85K |
| D2335 |
|
377 |
53 |
$73K |
| D1206 |
Topical application of fluoride varnish |
3,285 |
3,105 |
$64K |
| D0340 |
|
1,015 |
924 |
$59K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,327 |
2,121 |
$54K |
| D0330 |
Panoramic radiographic image |
970 |
806 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
3,184 |
2,891 |
$40K |
| D0210 |
Intraoral - complete series of radiographic images |
1,636 |
1,525 |
$29K |
| D0350 |
|
858 |
784 |
$27K |
| D1120 |
Prophylaxis - child |
806 |
752 |
$26K |
| D2330 |
|
256 |
98 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
231 |
91 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
646 |
610 |
$22K |
| D1351 |
Sealant - per tooth |
542 |
134 |
$18K |
| D4342 |
|
171 |
65 |
$16K |
| D9945 |
|
37 |
37 |
$10K |
| D4341 |
|
32 |
13 |
$9K |
| D2740 |
Crown - porcelain/ceramic |
19 |
15 |
$8K |
| D9940 |
|
26 |
25 |
$7K |
| D3120 |
|
166 |
40 |
$6K |
| D2950 |
|
42 |
36 |
$5K |
| D4910 |
|
77 |
77 |
$5K |
| D0180 |
|
88 |
88 |
$4K |
| D0470 |
|
57 |
40 |
$3K |
| D0272 |
Bitewings - two radiographic images |
98 |
78 |
$2K |
| D8670 |
Periodic orthodontic treatment visit |
12 |
12 |
$2K |
| D0160 |
|
15 |
12 |
$1K |
| D0240 |
|
18 |
12 |
$480.15 |