| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,005 |
1,870 |
$246K |
| D1110 |
Prophylaxis - adult |
5,869 |
5,819 |
$213K |
| D1206 |
Topical application of fluoride varnish |
8,683 |
8,577 |
$211K |
| D1351 |
Sealant - per tooth |
6,805 |
1,392 |
$182K |
| D0210 |
Intraoral - complete series of radiographic images |
3,428 |
3,382 |
$169K |
| D2740 |
Crown - porcelain/ceramic |
449 |
383 |
$157K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,871 |
5,805 |
$141K |
| D0120 |
Periodic oral evaluation - established patient |
5,088 |
5,052 |
$124K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,213 |
913 |
$113K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,194 |
685 |
$110K |
| D1120 |
Prophylaxis - child |
2,679 |
2,664 |
$77K |
| D0274 |
Bitewings - four radiographic images |
3,810 |
3,781 |
$76K |
| D0140 |
Limited oral evaluation - problem focused |
2,428 |
2,398 |
$56K |
| D2950 |
|
677 |
579 |
$52K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
730 |
501 |
$48K |
| D0330 |
Panoramic radiographic image |
819 |
813 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
245 |
91 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
2,244 |
2,203 |
$14K |
| D0272 |
Bitewings - two radiographic images |
581 |
581 |
$8K |
| D2330 |
|
95 |
56 |
$6K |
| D2332 |
|
68 |
39 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
951 |
475 |
$4K |
| D4341 |
|
30 |
14 |
$3K |
| D1999 |
|
216 |
181 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
21 |
18 |
$306.00 |
| D0270 |
|
16 |
16 |
$137.70 |