| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,261 |
2,255 |
$73K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
976 |
804 |
$70K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
647 |
550 |
$51K |
| D2335 |
|
418 |
362 |
$48K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
734 |
638 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
2,068 |
2,063 |
$33K |
| D2954 |
|
203 |
194 |
$27K |
| D2160 |
|
311 |
271 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
938 |
934 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,015 |
2,009 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,188 |
1,186 |
$24K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
310 |
273 |
$23K |
| D2791 |
|
55 |
54 |
$23K |
| D1351 |
Sealant - per tooth |
413 |
215 |
$23K |
| D0274 |
Bitewings - four radiographic images |
1,228 |
1,225 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
2,605 |
2,599 |
$19K |
| D1120 |
Prophylaxis - child |
639 |
639 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
230 |
176 |
$12K |
| D4341 |
|
148 |
96 |
$10K |
| D2330 |
|
199 |
155 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
814 |
814 |
$9K |
| D0272 |
Bitewings - two radiographic images |
712 |
712 |
$7K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
12 |
12 |
$6K |
| D2140 |
|
104 |
92 |
$5K |
| D3320 |
|
16 |
15 |
$5K |
| D2332 |
|
13 |
12 |
$1K |
| D2161 |
|
14 |
14 |
$1K |