| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,632 |
1,592 |
$193K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,971 |
1,533 |
$178K |
| D0120 |
Periodic oral evaluation - established patient |
6,893 |
6,724 |
$155K |
| D1110 |
Prophylaxis - adult |
4,895 |
4,753 |
$153K |
| D1120 |
Prophylaxis - child |
2,529 |
2,507 |
$108K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,295 |
4,668 |
$98K |
| D0274 |
Bitewings - four radiographic images |
2,832 |
2,775 |
$79K |
| D0140 |
Limited oral evaluation - problem focused |
2,365 |
2,319 |
$65K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,230 |
2,216 |
$59K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
607 |
423 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
960 |
941 |
$40K |
| D0272 |
Bitewings - two radiographic images |
1,478 |
1,448 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
164 |
92 |
$9K |
| D2335 |
|
70 |
49 |
$7K |
| D2954 |
|
49 |
27 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
88 |
61 |
$5K |
| D2330 |
|
84 |
55 |
$5K |
| D2332 |
|
30 |
26 |
$3K |
| D2140 |
|
54 |
28 |
$2K |
| D2331 |
|
34 |
25 |
$2K |
| D9945 |
|
14 |
14 |
$2K |
| D1351 |
Sealant - per tooth |
44 |
13 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
109 |
107 |
$1K |