| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19,424 |
5,941 |
$1.79M |
| D7140 |
Extraction, erupted tooth or exposed root |
2,818 |
1,090 |
$289K |
| D0140 |
Limited oral evaluation - problem focused |
6,417 |
5,585 |
$274K |
| D1120 |
Prophylaxis - child |
5,873 |
5,776 |
$246K |
| D0120 |
Periodic oral evaluation - established patient |
8,517 |
8,381 |
$245K |
| D9248 |
|
1,231 |
1,174 |
$229K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,274 |
9,118 |
$211K |
| D1110 |
Prophylaxis - adult |
3,201 |
3,146 |
$185K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,797 |
9,209 |
$179K |
| D2332 |
|
1,396 |
511 |
$173K |
| D1351 |
Sealant - per tooth |
5,174 |
1,112 |
$170K |
| D0220 |
Intraoral - periapical first radiographic image |
9,810 |
9,224 |
$88K |
| D2335 |
|
551 |
224 |
$83K |
| D0274 |
Bitewings - four radiographic images |
3,540 |
3,479 |
$77K |
| D0272 |
Bitewings - two radiographic images |
5,057 |
4,970 |
$75K |
| D2330 |
|
888 |
305 |
$75K |
| D0330 |
Panoramic radiographic image |
871 |
850 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
649 |
637 |
$33K |
| D1330 |
|
5,523 |
5,428 |
$33K |
| D0460 |
|
1,837 |
1,742 |
$18K |
| D3120 |
|
252 |
211 |
$9K |
| D9951 |
|
43 |
43 |
$1K |
| D0240 |
|
51 |
51 |
$891.00 |