| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,931 |
1,851 |
$411K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,747 |
1,388 |
$252K |
| D1110 |
Prophylaxis - adult |
4,412 |
4,300 |
$239K |
| D2332 |
|
1,581 |
830 |
$177K |
| D2335 |
|
1,014 |
577 |
$145K |
| D0120 |
Periodic oral evaluation - established patient |
4,894 |
4,803 |
$120K |
| D0274 |
Bitewings - four radiographic images |
3,069 |
3,021 |
$116K |
| D2330 |
|
1,625 |
810 |
$115K |
| D0210 |
Intraoral - complete series of radiographic images |
1,453 |
1,399 |
$102K |
| D2331 |
|
1,068 |
597 |
$96K |
| D1120 |
Prophylaxis - child |
1,755 |
1,732 |
$94K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
925 |
616 |
$87K |
| D0220 |
Intraoral - periapical first radiographic image |
4,654 |
4,533 |
$77K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,463 |
2,433 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,434 |
1,387 |
$67K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,460 |
3,803 |
$63K |
| D1351 |
Sealant - per tooth |
1,439 |
455 |
$59K |
| D0140 |
Limited oral evaluation - problem focused |
951 |
911 |
$38K |
| D0330 |
Panoramic radiographic image |
617 |
598 |
$36K |
| D7140 |
Extraction, erupted tooth or exposed root |
93 |
58 |
$8K |
| D2950 |
|
35 |
28 |
$5K |
| D0272 |
Bitewings - two radiographic images |
103 |
101 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
15 |
13 |
$2K |
| D2394 |
|
17 |
12 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
23 |
13 |
$1K |