| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,766 |
1,110 |
$358K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,216 |
576 |
$204K |
| D1110 |
Prophylaxis - adult |
1,667 |
1,638 |
$104K |
| D2750 |
|
208 |
158 |
$102K |
| D1120 |
Prophylaxis - child |
1,692 |
1,665 |
$74K |
| D0120 |
Periodic oral evaluation - established patient |
2,456 |
2,420 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,114 |
1,100 |
$60K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
517 |
290 |
$52K |
| D0140 |
Limited oral evaluation - problem focused |
886 |
860 |
$41K |
| D1206 |
Topical application of fluoride varnish |
1,449 |
1,426 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,270 |
1,247 |
$29K |
| D0274 |
Bitewings - four radiographic images |
1,266 |
1,241 |
$29K |
| D2950 |
|
174 |
137 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,220 |
1,175 |
$13K |
| D1351 |
Sealant - per tooth |
321 |
64 |
$11K |
| D0330 |
Panoramic radiographic image |
219 |
213 |
$10K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
13 |
$10K |
| D0272 |
Bitewings - two radiographic images |
479 |
473 |
$7K |
| D2394 |
|
37 |
27 |
$6K |
| D1330 |
|
932 |
920 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
77 |
76 |
$4K |
| D2331 |
|
35 |
29 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
402 |
392 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
26 |
12 |
$3K |