| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,224 |
3,205 |
$417K |
| D0120 |
Periodic oral evaluation - established patient |
6,991 |
6,821 |
$161K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,577 |
866 |
$142K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,347 |
7,163 |
$139K |
| D1110 |
Prophylaxis - adult |
4,422 |
4,302 |
$137K |
| D2330 |
|
2,647 |
1,404 |
$134K |
| D0210 |
Intraoral - complete series of radiographic images |
2,416 |
2,351 |
$124K |
| D1120 |
Prophylaxis - child |
2,852 |
2,794 |
$120K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,241 |
838 |
$114K |
| D0274 |
Bitewings - four radiographic images |
2,622 |
2,571 |
$81K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,059 |
720 |
$76K |
| D1351 |
Sealant - per tooth |
1,531 |
465 |
$58K |
| D2140 |
|
977 |
577 |
$47K |
| D0330 |
Panoramic radiographic image |
490 |
482 |
$37K |
| D2331 |
|
491 |
345 |
$35K |
| D2335 |
|
264 |
187 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
1,893 |
1,812 |
$21K |
| D2950 |
|
328 |
228 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
445 |
428 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
618 |
590 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,446 |
833 |
$14K |
| D2332 |
|
148 |
98 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
116 |
73 |
$6K |
| D7111 |
|
49 |
29 |
$4K |
| D0272 |
Bitewings - two radiographic images |
111 |
111 |
$3K |