| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,269 |
1,187 |
$395K |
| D1120 |
Prophylaxis - child |
5,168 |
4,687 |
$229K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,327 |
7,653 |
$221K |
| D0120 |
Periodic oral evaluation - established patient |
6,184 |
5,709 |
$159K |
| D1110 |
Prophylaxis - adult |
3,141 |
2,748 |
$155K |
| D0274 |
Bitewings - four radiographic images |
3,930 |
3,528 |
$141K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,153 |
502 |
$105K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,041 |
472 |
$93K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,772 |
1,516 |
$75K |
| D0330 |
Panoramic radiographic image |
1,724 |
1,443 |
$68K |
| D9110 |
|
919 |
735 |
$52K |
| D2740 |
Crown - porcelain/ceramic |
98 |
47 |
$50K |
| D2140 |
|
823 |
189 |
$47K |
| D1351 |
Sealant - per tooth |
1,329 |
290 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
692 |
594 |
$28K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
341 |
146 |
$26K |
| D8670 |
Periodic orthodontic treatment visit |
71 |
67 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
398 |
371 |
$7K |
| D7111 |
|
92 |
42 |
$5K |
| D0270 |
|
339 |
305 |
$5K |
| D4342 |
|
61 |
24 |
$5K |
| D0272 |
Bitewings - two radiographic images |
152 |
143 |
$4K |
| D2330 |
|
44 |
13 |
$3K |