| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,209 |
1,851 |
$422K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,645 |
1,007 |
$160K |
| D1120 |
Prophylaxis - child |
5,650 |
5,512 |
$135K |
| D0120 |
Periodic oral evaluation - established patient |
6,276 |
6,109 |
$129K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,252 |
700 |
$92K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,285 |
5,233 |
$81K |
| D1110 |
Prophylaxis - adult |
1,682 |
1,614 |
$69K |
| D1206 |
Topical application of fluoride varnish |
1,991 |
1,852 |
$52K |
| D0274 |
Bitewings - four radiographic images |
1,616 |
1,556 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
967 |
950 |
$33K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
320 |
219 |
$32K |
| D0272 |
Bitewings - two radiographic images |
2,506 |
2,452 |
$30K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
326 |
129 |
$18K |
| D2140 |
|
211 |
87 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
761 |
721 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
47 |
32 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
107 |
105 |
$3K |
| D2160 |
|
39 |
26 |
$2K |