| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,128 |
1,448 |
$193K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,403 |
4,777 |
$96K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,865 |
2,303 |
$89K |
| D1110 |
Prophylaxis - adult |
3,205 |
2,800 |
$89K |
| D1120 |
Prophylaxis - child |
2,258 |
2,050 |
$88K |
| D0210 |
Intraoral - complete series of radiographic images |
2,011 |
1,702 |
$88K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,527 |
795 |
$80K |
| D0120 |
Periodic oral evaluation - established patient |
3,317 |
3,008 |
$73K |
| D0274 |
Bitewings - four radiographic images |
2,319 |
2,064 |
$66K |
| D0140 |
Limited oral evaluation - problem focused |
2,461 |
2,144 |
$59K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
453 |
276 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
2,480 |
2,158 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
419 |
197 |
$23K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
255 |
88 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,001 |
671 |
$9K |
| D1351 |
Sealant - per tooth |
253 |
78 |
$8K |
| D2140 |
|
154 |
91 |
$7K |
| D2332 |
|
80 |
41 |
$6K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
25 |
12 |
$6K |
| D2330 |
|
105 |
54 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
101 |
64 |
$5K |
| D7250 |
|
44 |
12 |
$2K |
| D8660 |
|
35 |
16 |
$538.08 |
| D9310 |
|
21 |
17 |
$331.84 |
| D1320 |
|
55 |
45 |
$32.28 |
| D1999 |
|
20 |
18 |
$0.00 |