| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,035 |
2,441 |
$282K |
| D1110 |
Prophylaxis - adult |
6,508 |
6,377 |
$234K |
| D0120 |
Periodic oral evaluation - established patient |
8,033 |
7,882 |
$138K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,785 |
1,363 |
$133K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,303 |
1,538 |
$121K |
| D0274 |
Bitewings - four radiographic images |
5,240 |
5,100 |
$108K |
| D1206 |
Topical application of fluoride varnish |
6,093 |
5,964 |
$96K |
| D1120 |
Prophylaxis - child |
2,943 |
2,874 |
$78K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,202 |
3,091 |
$76K |
| D7140 |
Extraction, erupted tooth or exposed root |
834 |
350 |
$43K |
| D2740 |
Crown - porcelain/ceramic |
118 |
77 |
$31K |
| D0330 |
Panoramic radiographic image |
1,349 |
1,308 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,506 |
1,461 |
$25K |
| D1351 |
Sealant - per tooth |
1,096 |
240 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
2,727 |
2,505 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
778 |
726 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
512 |
489 |
$19K |
| D4910 |
|
216 |
215 |
$12K |
| D4341 |
|
221 |
50 |
$12K |
| D2331 |
|
192 |
137 |
$11K |
| D0603 |
|
2,340 |
2,305 |
$11K |
| D0601 |
|
2,357 |
2,320 |
$11K |
| D2394 |
|
107 |
90 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,433 |
697 |
$5K |
| D2330 |
|
75 |
50 |
$3K |
| D2335 |
|
38 |
27 |
$3K |
| D2332 |
|
22 |
13 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
52 |
50 |
$1K |
| D0602 |
|
103 |
88 |
$433.50 |