| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,091 |
2,829 |
$229K |
| D0160 |
|
2,861 |
2,814 |
$136K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,754 |
1,417 |
$116K |
| D0210 |
Intraoral - complete series of radiographic images |
2,663 |
2,620 |
$112K |
| D1110 |
Prophylaxis - adult |
3,994 |
3,933 |
$112K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,301 |
1,633 |
$101K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,367 |
1,270 |
$94K |
| D1351 |
Sealant - per tooth |
4,882 |
1,034 |
$89K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,991 |
5,886 |
$74K |
| D1120 |
Prophylaxis - child |
3,042 |
2,996 |
$69K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
672 |
230 |
$57K |
| D0140 |
Limited oral evaluation - problem focused |
2,764 |
2,588 |
$55K |
| D0274 |
Bitewings - four radiographic images |
2,502 |
2,468 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,546 |
1,523 |
$32K |
| D2394 |
|
395 |
352 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
1,618 |
1,579 |
$28K |
| D1206 |
Topical application of fluoride varnish |
1,336 |
1,308 |
$23K |
| D0191 |
|
2,205 |
2,168 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
2,870 |
2,696 |
$22K |
| D2331 |
|
316 |
244 |
$15K |
| D4355 |
|
169 |
165 |
$12K |
| D2335 |
|
125 |
87 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,445 |
776 |
$8K |
| D0272 |
Bitewings - two radiographic images |
647 |
643 |
$8K |
| D9110 |
|
278 |
266 |
$7K |
| D0270 |
|
609 |
600 |
$4K |
| D2330 |
|
113 |
91 |
$4K |
| D0330 |
Panoramic radiographic image |
113 |
112 |
$3K |
| D2332 |
|
47 |
38 |
$3K |
| D1354 |
|
142 |
29 |
$1K |