| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,935 |
2,654 |
$364K |
| D1110 |
Prophylaxis - adult |
6,496 |
6,479 |
$259K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,281 |
1,786 |
$249K |
| D1120 |
Prophylaxis - child |
5,451 |
5,448 |
$213K |
| D1351 |
Sealant - per tooth |
7,024 |
1,392 |
$195K |
| D0120 |
Periodic oral evaluation - established patient |
7,480 |
7,473 |
$177K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,534 |
1,824 |
$174K |
| D1206 |
Topical application of fluoride varnish |
6,380 |
6,377 |
$157K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,564 |
1,186 |
$155K |
| D0140 |
Limited oral evaluation - problem focused |
4,220 |
4,156 |
$121K |
| D0210 |
Intraoral - complete series of radiographic images |
2,137 |
2,098 |
$117K |
| D0191 |
|
5,897 |
5,895 |
$112K |
| D0274 |
Bitewings - four radiographic images |
3,583 |
3,579 |
$103K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,742 |
1,738 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
4,074 |
4,002 |
$43K |
| D5110 |
|
103 |
103 |
$41K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
633 |
295 |
$31K |
| D2394 |
|
293 |
227 |
$26K |
| D0330 |
Panoramic radiographic image |
431 |
431 |
$19K |
| D2331 |
|
291 |
220 |
$17K |
| D5120 |
|
43 |
43 |
$17K |
| D2335 |
|
144 |
96 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,926 |
1,104 |
$12K |
| D2330 |
|
192 |
137 |
$10K |
| D2740 |
Crown - porcelain/ceramic |
14 |
12 |
$9K |
| D2332 |
|
90 |
69 |
$7K |
| D0272 |
Bitewings - two radiographic images |
268 |
268 |
$6K |
| D2950 |
|
16 |
14 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
36 |
25 |
$2K |
| D0190 |
|
29 |
29 |
$466.00 |