| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
15,492 |
15,473 |
$623K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,734 |
4,707 |
$512K |
| D0120 |
Periodic oral evaluation - established patient |
19,086 |
19,054 |
$389K |
| D0274 |
Bitewings - four radiographic images |
16,721 |
16,699 |
$338K |
| D0220 |
Intraoral - periapical first radiographic image |
21,314 |
21,071 |
$319K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,761 |
3,929 |
$301K |
| D4341 |
|
6,285 |
2,252 |
$257K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,126 |
1,496 |
$152K |
| D1120 |
Prophylaxis - child |
4,341 |
4,335 |
$130K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,680 |
7,671 |
$78K |
| D2330 |
|
1,792 |
868 |
$73K |
| D1351 |
Sealant - per tooth |
2,214 |
588 |
$60K |
| D2332 |
|
738 |
462 |
$56K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,929 |
4,891 |
$56K |
| D2331 |
|
928 |
540 |
$55K |
| D2335 |
|
366 |
259 |
$36K |
| D7140 |
Extraction, erupted tooth or exposed root |
752 |
506 |
$30K |
| D0272 |
Bitewings - two radiographic images |
2,336 |
2,334 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,075 |
1,075 |
$21K |
| D9110 |
|
812 |
782 |
$16K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
42 |
29 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
107 |
107 |
$1K |
| D2394 |
|
13 |
12 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
43 |
43 |
$41.77 |