| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
19,451 |
11,347 |
$1.79M |
| D1110 |
Prophylaxis - adult |
32,614 |
32,601 |
$1.37M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
14,161 |
8,768 |
$909K |
| D0120 |
Periodic oral evaluation - established patient |
30,405 |
30,388 |
$695K |
| D0274 |
Bitewings - four radiographic images |
25,052 |
25,047 |
$576K |
| D0220 |
Intraoral - periapical first radiographic image |
37,680 |
37,593 |
$472K |
| D1351 |
Sealant - per tooth |
7,166 |
2,881 |
$393K |
| D0230 |
Intraoral - periapical each additional radiographic image |
36,268 |
35,745 |
$359K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,102 |
2,561 |
$324K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
12,145 |
12,142 |
$304K |
| D1120 |
Prophylaxis - child |
8,405 |
8,398 |
$282K |
| D2752 |
|
429 |
398 |
$257K |
| D2335 |
|
1,381 |
1,238 |
$193K |
| D2332 |
|
1,570 |
1,347 |
$179K |
| D1206 |
Topical application of fluoride varnish |
5,971 |
5,969 |
$160K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,478 |
10,468 |
$136K |
| D0210 |
Intraoral - complete series of radiographic images |
13,040 |
12,969 |
$129K |
| D2331 |
|
971 |
853 |
$125K |
| D2330 |
|
1,348 |
1,212 |
$90K |
| D2954 |
|
410 |
398 |
$60K |
| D7140 |
Extraction, erupted tooth or exposed root |
807 |
779 |
$51K |
| D0272 |
Bitewings - two radiographic images |
3,363 |
3,363 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
2,770 |
2,743 |
$30K |
| D2394 |
|
249 |
235 |
$25K |
| D4341 |
|
294 |
198 |
$22K |
| D2750 |
|
56 |
37 |
$21K |
| D3320 |
|
43 |
39 |
$11K |
| D9110 |
|
12 |
12 |
$197.86 |