| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,518 |
1,445 |
$517K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,495 |
423 |
$495K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,412 |
1,257 |
$370K |
| D1110 |
Prophylaxis - adult |
6,246 |
5,950 |
$341K |
| D1120 |
Prophylaxis - child |
6,132 |
5,932 |
$301K |
| D0120 |
Periodic oral evaluation - established patient |
8,974 |
8,732 |
$233K |
| D0210 |
Intraoral - complete series of radiographic images |
3,077 |
2,934 |
$225K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,376 |
7,159 |
$210K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,250 |
3,117 |
$150K |
| D0140 |
Limited oral evaluation - problem focused |
2,817 |
2,710 |
$118K |
| D1351 |
Sealant - per tooth |
2,789 |
858 |
$108K |
| D9110 |
|
1,364 |
1,277 |
$86K |
| D0220 |
Intraoral - periapical first radiographic image |
3,947 |
3,794 |
$68K |
| D0274 |
Bitewings - four radiographic images |
1,600 |
1,572 |
$61K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,258 |
1,749 |
$48K |
| D7140 |
Extraction, erupted tooth or exposed root |
405 |
162 |
$42K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
425 |
216 |
$42K |
| D0272 |
Bitewings - two radiographic images |
1,474 |
1,448 |
$41K |
| D2140 |
|
517 |
366 |
$36K |
| D1206 |
Topical application of fluoride varnish |
1,073 |
1,070 |
$27K |
| D2330 |
|
292 |
125 |
$24K |
| D2932 |
|
28 |
12 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
38 |
26 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
32 |
14 |
$3K |
| D1999 |
|
1,936 |
1,761 |
$0.00 |