| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,082 |
3,067 |
$611K |
| D7140 |
Extraction, erupted tooth or exposed root |
10,155 |
3,655 |
$610K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,110 |
2,164 |
$331K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,394 |
1,518 |
$272K |
| D1110 |
Prophylaxis - adult |
6,347 |
6,324 |
$271K |
| D1120 |
Prophylaxis - child |
6,650 |
6,603 |
$256K |
| D0210 |
Intraoral - complete series of radiographic images |
4,675 |
4,599 |
$255K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,982 |
6,951 |
$250K |
| D0120 |
Periodic oral evaluation - established patient |
8,728 |
8,683 |
$204K |
| D0140 |
Limited oral evaluation - problem focused |
5,168 |
5,035 |
$163K |
| D0274 |
Bitewings - four radiographic images |
5,843 |
5,815 |
$159K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,086 |
7,034 |
$159K |
| D0220 |
Intraoral - periapical first radiographic image |
10,474 |
10,262 |
$130K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,437 |
7,480 |
$76K |
| D4341 |
|
537 |
208 |
$56K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
554 |
391 |
$42K |
| D1351 |
Sealant - per tooth |
1,240 |
203 |
$37K |
| D0272 |
Bitewings - two radiographic images |
1,644 |
1,628 |
$37K |
| D2335 |
|
237 |
157 |
$20K |
| D2394 |
|
101 |
82 |
$15K |
| D2332 |
|
245 |
136 |
$15K |
| D1206 |
Topical application of fluoride varnish |
442 |
442 |
$13K |
| D0270 |
|
846 |
830 |
$9K |
| D5110 |
|
12 |
12 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
168 |
168 |
$5K |
| D2331 |
|
42 |
26 |
$4K |
| D2330 |
|
91 |
53 |
$4K |
| D2950 |
|
12 |
12 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
22 |
15 |
$686.62 |