| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,891 |
1,023 |
$250K |
| D1110 |
Prophylaxis - adult |
2,683 |
2,641 |
$169K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
739 |
533 |
$124K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,710 |
1,686 |
$92K |
| D0120 |
Periodic oral evaluation - established patient |
2,870 |
2,825 |
$87K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
781 |
491 |
$80K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,314 |
3,266 |
$77K |
| D1120 |
Prophylaxis - child |
1,650 |
1,634 |
$72K |
| D0274 |
Bitewings - four radiographic images |
2,445 |
2,401 |
$57K |
| D1351 |
Sealant - per tooth |
1,580 |
243 |
$52K |
| D0140 |
Limited oral evaluation - problem focused |
931 |
876 |
$43K |
| D7140 |
Extraction, erupted tooth or exposed root |
252 |
97 |
$31K |
| D2394 |
|
171 |
136 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
2,544 |
2,442 |
$26K |
| D2750 |
|
50 |
38 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,182 |
1,159 |
$15K |
| D0272 |
Bitewings - two radiographic images |
739 |
734 |
$11K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$9K |
| D1330 |
|
1,345 |
1,324 |
$8K |
| D7240 |
Removal of impacted tooth - completely bony |
27 |
13 |
$8K |
| D2332 |
|
41 |
27 |
$6K |
| D2331 |
|
48 |
39 |
$6K |
| D0330 |
Panoramic radiographic image |
110 |
107 |
$5K |
| D2740 |
Crown - porcelain/ceramic |
14 |
13 |
$5K |
| D2335 |
|
18 |
13 |
$3K |
| D1206 |
Topical application of fluoride varnish |
106 |
106 |
$3K |
| D3120 |
|
63 |
57 |
$2K |
| D4355 |
|
13 |
13 |
$1K |