| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2394 |
|
1,882 |
1,379 |
$234K |
| D7250 |
|
2,558 |
778 |
$213K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,744 |
1,723 |
$207K |
| D1110 |
Prophylaxis - adult |
4,848 |
4,545 |
$161K |
| D1206 |
Topical application of fluoride varnish |
7,687 |
7,359 |
$153K |
| D0120 |
Periodic oral evaluation - established patient |
6,141 |
5,899 |
$151K |
| D0140 |
Limited oral evaluation - problem focused |
5,396 |
4,839 |
$151K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,611 |
1,309 |
$148K |
| D0274 |
Bitewings - four radiographic images |
4,356 |
4,166 |
$144K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,524 |
1,067 |
$139K |
| D1120 |
Prophylaxis - child |
2,940 |
2,875 |
$128K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,315 |
4,681 |
$121K |
| D0210 |
Intraoral - complete series of radiographic images |
2,315 |
2,152 |
$121K |
| D0220 |
Intraoral - periapical first radiographic image |
7,237 |
6,742 |
$88K |
| D2335 |
|
663 |
357 |
$73K |
| D0330 |
Panoramic radiographic image |
1,334 |
996 |
$72K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
844 |
766 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
419 |
221 |
$29K |
| D2161 |
|
181 |
133 |
$18K |
| D2332 |
|
170 |
94 |
$16K |
| D1351 |
Sealant - per tooth |
320 |
74 |
$12K |
| D2330 |
|
160 |
92 |
$10K |
| D2331 |
|
119 |
73 |
$9K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
17 |
12 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
51 |
13 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
27 |
24 |
$2K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$346.88 |