| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,622 |
1,510 |
$361K |
| D0210 |
Intraoral - complete series of radiographic images |
2,982 |
2,980 |
$247K |
| D1206 |
Topical application of fluoride varnish |
6,417 |
6,279 |
$235K |
| D1110 |
Prophylaxis - adult |
3,709 |
3,678 |
$222K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,350 |
4,292 |
$170K |
| D0120 |
Periodic oral evaluation - established patient |
4,266 |
4,237 |
$157K |
| D1351 |
Sealant - per tooth |
2,531 |
517 |
$132K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
656 |
421 |
$118K |
| D2740 |
Crown - porcelain/ceramic |
130 |
117 |
$84K |
| D0274 |
Bitewings - four radiographic images |
5,243 |
5,181 |
$83K |
| D1120 |
Prophylaxis - child |
1,871 |
1,870 |
$82K |
| D0330 |
Panoramic radiographic image |
4,279 |
4,219 |
$53K |
| D7140 |
Extraction, erupted tooth or exposed root |
516 |
128 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,858 |
3,213 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
5,339 |
5,079 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
306 |
219 |
$32K |
| D1999 |
|
2,766 |
2,643 |
$27K |
| D2950 |
|
135 |
125 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
432 |
424 |
$19K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
65 |
38 |
$10K |
| D4910 |
|
71 |
71 |
$5K |
| D0272 |
Bitewings - two radiographic images |
300 |
300 |
$4K |