| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,564 |
1,398 |
$221K |
| D1351 |
Sealant - per tooth |
5,570 |
821 |
$159K |
| D1110 |
Prophylaxis - adult |
2,881 |
2,744 |
$153K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,730 |
3,547 |
$152K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,487 |
625 |
$139K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
780 |
460 |
$139K |
| D0274 |
Bitewings - four radiographic images |
3,599 |
3,416 |
$135K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,768 |
995 |
$113K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,920 |
4,000 |
$87K |
| D0220 |
Intraoral - periapical first radiographic image |
5,084 |
4,761 |
$70K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
551 |
379 |
$60K |
| D0140 |
Limited oral evaluation - problem focused |
1,484 |
1,388 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
1,978 |
1,873 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,233 |
2,105 |
$48K |
| D1120 |
Prophylaxis - child |
1,084 |
1,020 |
$37K |
| D2335 |
|
121 |
70 |
$21K |
| D0330 |
Panoramic radiographic image |
271 |
253 |
$17K |
| D4346 |
|
86 |
82 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
867 |
613 |
$10K |
| D2332 |
|
86 |
55 |
$10K |
| D0270 |
|
461 |
413 |
$9K |
| D2331 |
|
79 |
57 |
$8K |
| D2394 |
|
13 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
78 |
76 |
$2K |
| D2330 |
|
17 |
12 |
$2K |