| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,900 |
4,824 |
$1.18M |
| D1110 |
Prophylaxis - adult |
15,145 |
14,961 |
$1.02M |
| D0120 |
Periodic oral evaluation - established patient |
23,777 |
23,500 |
$758K |
| D1208 |
Topical application of fluoride, excluding varnish |
30,469 |
30,113 |
$725K |
| D1120 |
Prophylaxis - child |
14,927 |
14,763 |
$667K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,003 |
8,873 |
$621K |
| D0274 |
Bitewings - four radiographic images |
13,175 |
12,997 |
$516K |
| D0220 |
Intraoral - periapical first radiographic image |
25,331 |
24,678 |
$429K |
| D0350 |
|
4,089 |
3,451 |
$400K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,999 |
2,261 |
$396K |
| D0230 |
Intraoral - periapical each additional radiographic image |
21,355 |
19,156 |
$312K |
| D0140 |
Limited oral evaluation - problem focused |
6,906 |
6,689 |
$308K |
| D1351 |
Sealant - per tooth |
6,671 |
1,674 |
$243K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,066 |
754 |
$172K |
| D0272 |
Bitewings - two radiographic images |
3,021 |
2,991 |
$111K |
| D0210 |
Intraoral - complete series of radiographic images |
1,239 |
1,215 |
$82K |
| D7140 |
Extraction, erupted tooth or exposed root |
623 |
386 |
$56K |
| D4341 |
|
263 |
79 |
$33K |
| D2331 |
|
57 |
29 |
$6K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
15 |
15 |
$5K |
| D2335 |
|
15 |
12 |
$2K |
| D0270 |
|
46 |
46 |
$789.92 |