| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,951 |
2,581 |
$404K |
| D1110 |
Prophylaxis - adult |
5,726 |
5,493 |
$211K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,566 |
1,705 |
$194K |
| D0120 |
Periodic oral evaluation - established patient |
7,774 |
7,428 |
$193K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,299 |
945 |
$160K |
| D0140 |
Limited oral evaluation - problem focused |
3,849 |
3,308 |
$132K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,162 |
755 |
$119K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,257 |
797 |
$115K |
| D0274 |
Bitewings - four radiographic images |
3,669 |
3,497 |
$113K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,214 |
5,950 |
$101K |
| D0330 |
Panoramic radiographic image |
1,764 |
1,685 |
$98K |
| D1120 |
Prophylaxis - child |
3,511 |
3,381 |
$90K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,708 |
1,603 |
$69K |
| D0220 |
Intraoral - periapical first radiographic image |
4,204 |
3,665 |
$61K |
| D1351 |
Sealant - per tooth |
1,264 |
430 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,594 |
1,529 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,230 |
1,997 |
$28K |
| D4355 |
|
108 |
107 |
$7K |
| D2140 |
|
70 |
53 |
$4K |
| D2394 |
|
16 |
13 |
$2K |
| D2160 |
|
13 |
12 |
$1K |
| D9110 |
|
25 |
25 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
17 |
13 |
$1K |