| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,809 |
2,181 |
$305K |
| D1120 |
Prophylaxis - child |
6,444 |
6,381 |
$284K |
| D0274 |
Bitewings - four radiographic images |
8,351 |
8,216 |
$269K |
| D1110 |
Prophylaxis - adult |
7,777 |
7,583 |
$262K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,311 |
11,174 |
$251K |
| D0120 |
Periodic oral evaluation - established patient |
9,574 |
9,401 |
$244K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,170 |
5,100 |
$237K |
| D0140 |
Limited oral evaluation - problem focused |
6,982 |
6,644 |
$194K |
| D0210 |
Intraoral - complete series of radiographic images |
1,647 |
1,577 |
$93K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
828 |
589 |
$86K |
| D0330 |
Panoramic radiographic image |
1,607 |
1,444 |
$83K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,214 |
660 |
$78K |
| D7140 |
Extraction, erupted tooth or exposed root |
847 |
508 |
$60K |
| D0220 |
Intraoral - periapical first radiographic image |
4,118 |
3,947 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,115 |
1,873 |
$31K |
| D2954 |
|
197 |
130 |
$27K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
41 |
28 |
$23K |
| D1351 |
Sealant - per tooth |
454 |
120 |
$17K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
242 |
194 |
$15K |
| D7230 |
|
73 |
45 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
72 |
32 |
$10K |
| D9310 |
|
377 |
369 |
$9K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
20 |
14 |
$8K |
| D2160 |
|
66 |
53 |
$5K |
| D2394 |
|
13 |
13 |
$1K |
| D0272 |
Bitewings - two radiographic images |
40 |
40 |
$1K |
| D0270 |
|
154 |
152 |
$993.72 |
| D2140 |
|
15 |
12 |
$784.70 |