| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,618 |
2,554 |
$461K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,708 |
2,164 |
$402K |
| D1120 |
Prophylaxis - child |
7,265 |
7,151 |
$292K |
| D1110 |
Prophylaxis - adult |
6,405 |
6,357 |
$263K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,754 |
2,044 |
$244K |
| D0120 |
Periodic oral evaluation - established patient |
9,335 |
9,216 |
$232K |
| D1351 |
Sealant - per tooth |
7,498 |
1,375 |
$226K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,083 |
6,017 |
$219K |
| D0210 |
Intraoral - complete series of radiographic images |
3,634 |
3,608 |
$182K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,508 |
7,383 |
$175K |
| D0140 |
Limited oral evaluation - problem focused |
4,990 |
4,874 |
$145K |
| D0274 |
Bitewings - four radiographic images |
4,729 |
4,685 |
$130K |
| D0220 |
Intraoral - periapical first radiographic image |
9,611 |
9,398 |
$125K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
894 |
668 |
$100K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,137 |
6,654 |
$63K |
| D0272 |
Bitewings - two radiographic images |
1,599 |
1,550 |
$35K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
242 |
186 |
$22K |
| D2950 |
|
71 |
55 |
$12K |
| D0145 |
Oral evaluation for a patient under three years of age |
288 |
288 |
$8K |
| D2335 |
|
84 |
52 |
$8K |
| D2331 |
|
109 |
66 |
$6K |
| D5110 |
|
13 |
13 |
$5K |
| D4341 |
|
31 |
12 |
$5K |
| D0330 |
Panoramic radiographic image |
170 |
170 |
$3K |
| D2330 |
|
35 |
27 |
$2K |
| D2332 |
|
28 |
12 |
$2K |
| D0270 |
|
117 |
117 |
$1K |