| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,041 |
3,186 |
$642K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,081 |
2,991 |
$587K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
7,422 |
3,248 |
$583K |
| D1110 |
Prophylaxis - adult |
15,664 |
15,587 |
$582K |
| D0210 |
Intraoral - complete series of radiographic images |
9,932 |
9,792 |
$486K |
| D5213 |
|
791 |
790 |
$477K |
| D5214 |
|
674 |
669 |
$428K |
| D0120 |
Periodic oral evaluation - established patient |
15,852 |
15,784 |
$357K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,120 |
3,218 |
$352K |
| D1120 |
Prophylaxis - child |
7,150 |
7,134 |
$289K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,109 |
9,080 |
$286K |
| D1351 |
Sealant - per tooth |
9,322 |
1,856 |
$278K |
| D2750 |
|
478 |
356 |
$253K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,038 |
8,026 |
$197K |
| D0230 |
Intraoral - periapical each additional radiographic image |
25,596 |
10,004 |
$190K |
| D0274 |
Bitewings - four radiographic images |
5,971 |
5,957 |
$161K |
| D0220 |
Intraoral - periapical first radiographic image |
12,739 |
12,461 |
$150K |
| D5110 |
|
281 |
277 |
$135K |
| D0140 |
Limited oral evaluation - problem focused |
3,556 |
3,407 |
$111K |
| D2335 |
|
1,184 |
762 |
$95K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
718 |
543 |
$94K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,440 |
1,536 |
$91K |
| D2950 |
|
485 |
373 |
$75K |
| D4355 |
|
1,589 |
1,564 |
$71K |
| D0240 |
|
2,803 |
1,403 |
$60K |
| D2330 |
|
794 |
482 |
$45K |
| D2332 |
|
566 |
352 |
$43K |
| D2140 |
|
1,902 |
1,020 |
$37K |
| D0272 |
Bitewings - two radiographic images |
1,530 |
1,525 |
$36K |
| D2160 |
|
803 |
610 |
$36K |
| D4341 |
|
223 |
86 |
$31K |
| D2331 |
|
371 |
259 |
$25K |
| D9248 |
|
390 |
277 |
$23K |
| D5120 |
|
18 |
18 |
$15K |
| D3320 |
|
16 |
13 |
$5K |
| D1206 |
Topical application of fluoride varnish |
121 |
121 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
15 |
12 |
$2K |
| D2161 |
|
17 |
14 |
$909.57 |
| D0145 |
Oral evaluation for a patient under three years of age |
16 |
16 |
$435.00 |