| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,980 |
3,042 |
$605K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,857 |
2,283 |
$361K |
| D1120 |
Prophylaxis - child |
5,904 |
5,900 |
$233K |
| D0120 |
Periodic oral evaluation - established patient |
7,883 |
7,878 |
$211K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,455 |
1,061 |
$209K |
| D1110 |
Prophylaxis - adult |
4,033 |
4,030 |
$204K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,184 |
7,182 |
$172K |
| D0274 |
Bitewings - four radiographic images |
4,120 |
4,118 |
$126K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,959 |
1,957 |
$83K |
| D0210 |
Intraoral - complete series of radiographic images |
1,285 |
1,262 |
$80K |
| D0140 |
Limited oral evaluation - problem focused |
1,774 |
1,734 |
$75K |
| D0220 |
Intraoral - periapical first radiographic image |
3,872 |
3,760 |
$62K |
| D0330 |
Panoramic radiographic image |
858 |
857 |
$56K |
| D1351 |
Sealant - per tooth |
1,602 |
227 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,838 |
1,695 |
$25K |
| D0272 |
Bitewings - two radiographic images |
952 |
952 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
241 |
164 |
$20K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
13 |
$8K |
| D2740 |
Crown - porcelain/ceramic |
15 |
12 |
$8K |
| D2394 |
|
30 |
26 |
$5K |
| D2950 |
|
13 |
12 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
15 |
12 |
$2K |
| D1206 |
Topical application of fluoride varnish |
40 |
40 |
$1K |