| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,676 |
2,197 |
$349K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,157 |
1,896 |
$205K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,114 |
1,183 |
$170K |
| D2332 |
|
2,185 |
853 |
$148K |
| D1110 |
Prophylaxis - adult |
3,887 |
3,869 |
$120K |
| D0120 |
Periodic oral evaluation - established patient |
3,463 |
3,448 |
$71K |
| D0210 |
Intraoral - complete series of radiographic images |
1,557 |
1,543 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,476 |
2,457 |
$57K |
| D1120 |
Prophylaxis - child |
1,222 |
1,215 |
$49K |
| D0274 |
Bitewings - four radiographic images |
2,327 |
2,317 |
$44K |
| D4355 |
|
753 |
748 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
1,649 |
1,577 |
$35K |
| D7140 |
Extraction, erupted tooth or exposed root |
880 |
353 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
3,938 |
3,855 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,311 |
1,306 |
$32K |
| D2394 |
|
361 |
244 |
$30K |
| D2335 |
|
354 |
222 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,641 |
3,116 |
$21K |
| D2331 |
|
245 |
157 |
$12K |
| D2330 |
|
211 |
112 |
$9K |
| D0272 |
Bitewings - two radiographic images |
323 |
322 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
160 |
80 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
151 |
62 |
$5K |
| D2140 |
|
157 |
44 |
$2K |
| D1206 |
Topical application of fluoride varnish |
228 |
228 |
$0.00 |