| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,758 |
2,747 |
$506K |
| D1351 |
Sealant - per tooth |
15,006 |
1,862 |
$448K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,973 |
2,076 |
$313K |
| D1110 |
Prophylaxis - adult |
6,770 |
6,762 |
$298K |
| D1120 |
Prophylaxis - child |
7,472 |
7,468 |
$294K |
| D0120 |
Periodic oral evaluation - established patient |
9,460 |
9,457 |
$241K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,736 |
1,684 |
$224K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,908 |
5,904 |
$224K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,313 |
920 |
$172K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,493 |
7,479 |
$170K |
| D0210 |
Intraoral - complete series of radiographic images |
2,550 |
2,490 |
$156K |
| D0274 |
Bitewings - four radiographic images |
5,338 |
5,337 |
$151K |
| D0220 |
Intraoral - periapical first radiographic image |
8,181 |
8,095 |
$111K |
| D0140 |
Limited oral evaluation - problem focused |
3,153 |
3,108 |
$106K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
637 |
251 |
$97K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,525 |
5,798 |
$58K |
| D0272 |
Bitewings - two radiographic images |
1,985 |
1,983 |
$43K |
| D2331 |
|
387 |
237 |
$32K |
| D1206 |
Topical application of fluoride varnish |
959 |
959 |
$23K |
| D2335 |
|
111 |
83 |
$17K |
| D2332 |
|
133 |
79 |
$15K |
| D2950 |
|
65 |
52 |
$12K |
| D2330 |
|
164 |
104 |
$10K |
| D0145 |
Oral evaluation for a patient under three years of age |
389 |
389 |
$9K |
| D0270 |
|
624 |
615 |
$7K |
| D2394 |
|
35 |
26 |
$5K |
| D1999 |
|
1,426 |
1,260 |
$0.00 |