| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,500 |
1,874 |
$311K |
| D0210 |
Intraoral - complete series of radiographic images |
2,899 |
2,779 |
$204K |
| D1110 |
Prophylaxis - adult |
4,317 |
4,211 |
$185K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,679 |
892 |
$138K |
| D0120 |
Periodic oral evaluation - established patient |
4,696 |
4,617 |
$105K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,267 |
3,214 |
$103K |
| D0274 |
Bitewings - four radiographic images |
3,027 |
2,957 |
$78K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,023 |
3,969 |
$76K |
| D1120 |
Prophylaxis - child |
2,724 |
2,686 |
$68K |
| D7140 |
Extraction, erupted tooth or exposed root |
562 |
216 |
$52K |
| D0140 |
Limited oral evaluation - problem focused |
1,623 |
1,459 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,953 |
3,112 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
4,023 |
3,815 |
$26K |
| D2394 |
|
221 |
135 |
$24K |
| D2931 |
|
86 |
65 |
$18K |
| D2950 |
|
126 |
96 |
$18K |
| D0272 |
Bitewings - two radiographic images |
1,298 |
1,286 |
$17K |
| D2335 |
|
54 |
26 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
138 |
59 |
$7K |
| D4341 |
|
38 |
12 |
$6K |
| D2331 |
|
79 |
52 |
$6K |
| D2160 |
|
88 |
42 |
$6K |
| D1351 |
Sealant - per tooth |
98 |
27 |
$4K |
| D4910 |
|
82 |
79 |
$3K |
| D2332 |
|
15 |
13 |
$2K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$555.84 |