| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,973 |
1,194 |
$104K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,591 |
1,013 |
$101K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,934 |
873 |
$98K |
| D1110 |
Prophylaxis - adult |
2,916 |
2,845 |
$93K |
| D2394 |
|
1,162 |
725 |
$85K |
| D0330 |
Panoramic radiographic image |
1,293 |
1,256 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
3,325 |
3,254 |
$54K |
| D0274 |
Bitewings - four radiographic images |
1,903 |
1,868 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,396 |
1,368 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
712 |
456 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,123 |
2,101 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
1,369 |
1,334 |
$28K |
| D1120 |
Prophylaxis - child |
1,276 |
1,267 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,452 |
1,870 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
3,015 |
2,929 |
$14K |
| D2335 |
|
170 |
82 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
336 |
308 |
$12K |
| D1351 |
Sealant - per tooth |
424 |
127 |
$9K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
76 |
44 |
$4K |
| D0272 |
Bitewings - two radiographic images |
381 |
378 |
$4K |
| D1206 |
Topical application of fluoride varnish |
257 |
255 |
$3K |
| D2160 |
|
46 |
35 |
$3K |
| D2332 |
|
43 |
26 |
$3K |
| D2140 |
|
62 |
40 |
$2K |