| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,013 |
1,568 |
$204K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,498 |
7,895 |
$157K |
| D1110 |
Prophylaxis - adult |
5,222 |
4,770 |
$151K |
| D1120 |
Prophylaxis - child |
3,431 |
3,258 |
$140K |
| D0120 |
Periodic oral evaluation - established patient |
5,745 |
5,399 |
$133K |
| D0210 |
Intraoral - complete series of radiographic images |
2,654 |
2,417 |
$122K |
| D0140 |
Limited oral evaluation - problem focused |
4,625 |
4,251 |
$114K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,361 |
2,822 |
$113K |
| D0274 |
Bitewings - four radiographic images |
3,655 |
3,406 |
$104K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,285 |
726 |
$69K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,113 |
497 |
$66K |
| D0220 |
Intraoral - periapical first radiographic image |
4,086 |
3,770 |
$40K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
77 |
49 |
$25K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
369 |
228 |
$20K |
| D2950 |
|
489 |
269 |
$18K |
| D2332 |
|
209 |
118 |
$18K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
141 |
63 |
$9K |
| D0272 |
Bitewings - two radiographic images |
274 |
266 |
$7K |
| D2140 |
|
74 |
53 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
35 |
28 |
$3K |
| D1351 |
Sealant - per tooth |
63 |
12 |
$2K |
| D2330 |
|
36 |
26 |
$2K |
| D0270 |
|
205 |
181 |
$1K |
| D0330 |
Panoramic radiographic image |
29 |
17 |
$849.99 |
| D0230 |
Intraoral - periapical each additional radiographic image |
16 |
12 |
$157.08 |