| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,208 |
3,410 |
$587K |
| D1351 |
Sealant - per tooth |
13,958 |
1,832 |
$419K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,190 |
2,267 |
$309K |
| D1110 |
Prophylaxis - adult |
6,821 |
6,797 |
$299K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,060 |
1,333 |
$235K |
| D0120 |
Periodic oral evaluation - established patient |
8,077 |
8,059 |
$202K |
| D1120 |
Prophylaxis - child |
4,861 |
4,858 |
$194K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,552 |
1,760 |
$184K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,166 |
5,156 |
$181K |
| D0210 |
Intraoral - complete series of radiographic images |
3,529 |
3,487 |
$171K |
| D0140 |
Limited oral evaluation - problem focused |
4,200 |
4,091 |
$137K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,156 |
583 |
$136K |
| D0274 |
Bitewings - four radiographic images |
4,507 |
4,495 |
$132K |
| D0220 |
Intraoral - periapical first radiographic image |
8,740 |
8,575 |
$121K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,196 |
5,194 |
$120K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,039 |
5,605 |
$56K |
| D2950 |
|
197 |
141 |
$29K |
| D0272 |
Bitewings - two radiographic images |
1,284 |
1,280 |
$27K |
| D2331 |
|
317 |
171 |
$22K |
| D3320 |
|
37 |
30 |
$19K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
16 |
13 |
$11K |
| D0270 |
|
1,049 |
1,044 |
$10K |
| D2394 |
|
61 |
48 |
$10K |
| D2332 |
|
71 |
43 |
$9K |
| D2330 |
|
107 |
65 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
105 |
105 |
$3K |
| D1999 |
|
88 |
85 |
$0.00 |