| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,481 |
2,483 |
$301K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,236 |
2,519 |
$297K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,750 |
10,231 |
$215K |
| D1110 |
Prophylaxis - adult |
6,447 |
6,108 |
$212K |
| D1120 |
Prophylaxis - child |
4,551 |
4,460 |
$198K |
| D0210 |
Intraoral - complete series of radiographic images |
3,472 |
3,267 |
$184K |
| D0120 |
Periodic oral evaluation - established patient |
7,023 |
6,762 |
$174K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,459 |
3,818 |
$169K |
| D0140 |
Limited oral evaluation - problem focused |
5,872 |
5,495 |
$160K |
| D0274 |
Bitewings - four radiographic images |
4,845 |
4,649 |
$152K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
272 |
208 |
$115K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,291 |
607 |
$86K |
| D0330 |
Panoramic radiographic image |
991 |
959 |
$78K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,920 |
3,091 |
$57K |
| D1351 |
Sealant - per tooth |
1,260 |
358 |
$46K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
559 |
383 |
$44K |
| D2991 |
|
442 |
95 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
2,495 |
2,269 |
$26K |
| D0272 |
Bitewings - two radiographic images |
918 |
888 |
$24K |
| D2954 |
|
172 |
117 |
$21K |
| D2140 |
|
355 |
222 |
$17K |
| D2331 |
|
148 |
103 |
$11K |
| D0270 |
|
1,008 |
930 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
96 |
80 |
$6K |
| D2330 |
|
106 |
69 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
21 |
14 |
$2K |
| D2332 |
|
22 |
12 |
$2K |