| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,634 |
2,637 |
$739K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,530 |
1,745 |
$576K |
| D1351 |
Sealant - per tooth |
14,453 |
2,667 |
$506K |
| D1110 |
Prophylaxis - adult |
7,425 |
7,319 |
$474K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,649 |
7,505 |
$410K |
| D1120 |
Prophylaxis - child |
6,963 |
6,822 |
$308K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,456 |
803 |
$246K |
| D0120 |
Periodic oral evaluation - established patient |
7,469 |
7,346 |
$229K |
| D0274 |
Bitewings - four radiographic images |
7,374 |
7,286 |
$172K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,485 |
803 |
$152K |
| D0140 |
Limited oral evaluation - problem focused |
3,092 |
3,047 |
$144K |
| D0220 |
Intraoral - periapical first radiographic image |
13,205 |
12,849 |
$137K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,751 |
5,606 |
$131K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,341 |
11,133 |
$103K |
| D1206 |
Topical application of fluoride varnish |
3,951 |
3,910 |
$100K |
| D2332 |
|
390 |
213 |
$54K |
| D2335 |
|
272 |
168 |
$46K |
| D0272 |
Bitewings - two radiographic images |
1,669 |
1,631 |
$26K |
| D1330 |
|
1,492 |
1,492 |
$11K |
| D2331 |
|
92 |
52 |
$10K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
26 |
16 |
$10K |
| D2950 |
|
56 |
48 |
$5K |