| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,398 |
751 |
$151K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,446 |
491 |
$123K |
| D1110 |
Prophylaxis - adult |
3,455 |
3,023 |
$115K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,543 |
471 |
$82K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,436 |
550 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
4,394 |
3,752 |
$73K |
| D0210 |
Intraoral - complete series of radiographic images |
1,110 |
882 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,803 |
1,528 |
$46K |
| D2332 |
|
608 |
155 |
$43K |
| D2931 |
|
375 |
231 |
$41K |
| D1120 |
Prophylaxis - child |
1,581 |
1,285 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,073 |
1,641 |
$31K |
| D0330 |
Panoramic radiographic image |
673 |
654 |
$28K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
479 |
195 |
$27K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
419 |
164 |
$23K |
| D2160 |
|
346 |
125 |
$22K |
| D2330 |
|
404 |
101 |
$21K |
| D0274 |
Bitewings - four radiographic images |
1,003 |
957 |
$19K |
| D2140 |
|
296 |
91 |
$12K |
| D1351 |
Sealant - per tooth |
411 |
77 |
$9K |
| D0272 |
Bitewings - two radiographic images |
901 |
661 |
$9K |
| D2394 |
|
103 |
37 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
959 |
813 |
$5K |
| D1206 |
Topical application of fluoride varnish |
256 |
255 |
$4K |
| D2335 |
|
34 |
14 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
127 |
117 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
270 |
108 |
$1K |