| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,007 |
1,914 |
$213K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,777 |
1,004 |
$115K |
| D1110 |
Prophylaxis - adult |
3,112 |
3,006 |
$104K |
| D0210 |
Intraoral - complete series of radiographic images |
2,091 |
1,998 |
$97K |
| D0120 |
Periodic oral evaluation - established patient |
4,082 |
3,947 |
$69K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,156 |
510 |
$66K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,227 |
767 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,430 |
2,348 |
$59K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,573 |
3,447 |
$52K |
| D1120 |
Prophylaxis - child |
2,635 |
2,551 |
$51K |
| D0274 |
Bitewings - four radiographic images |
2,448 |
2,369 |
$48K |
| D2331 |
|
541 |
362 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
1,327 |
1,176 |
$29K |
| D2394 |
|
345 |
223 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,266 |
2,463 |
$27K |
| D2335 |
|
241 |
123 |
$23K |
| D2931 |
|
154 |
126 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
3,159 |
2,993 |
$16K |
| D2332 |
|
200 |
129 |
$15K |
| D0272 |
Bitewings - two radiographic images |
1,300 |
1,260 |
$13K |
| D0330 |
Panoramic radiographic image |
272 |
250 |
$11K |
| D1351 |
Sealant - per tooth |
88 |
33 |
$2K |
| D2330 |
|
23 |
14 |
$1K |
| D1320 |
|
26 |
26 |
$446.99 |
| D0240 |
|
40 |
16 |
$390.60 |