| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,820 |
3,554 |
$571K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,126 |
2,652 |
$292K |
| D1110 |
Prophylaxis - adult |
7,484 |
7,378 |
$287K |
| D0120 |
Periodic oral evaluation - established patient |
8,389 |
8,310 |
$194K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,907 |
1,407 |
$191K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,762 |
1,861 |
$182K |
| D1120 |
Prophylaxis - child |
3,649 |
3,632 |
$147K |
| D0210 |
Intraoral - complete series of radiographic images |
2,537 |
2,485 |
$116K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,327 |
3,281 |
$112K |
| D0140 |
Limited oral evaluation - problem focused |
3,957 |
3,764 |
$111K |
| D0220 |
Intraoral - periapical first radiographic image |
9,005 |
8,674 |
$107K |
| D0274 |
Bitewings - four radiographic images |
3,899 |
3,859 |
$104K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,094 |
4,075 |
$98K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,460 |
6,618 |
$62K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,243 |
628 |
$56K |
| D2331 |
|
612 |
391 |
$30K |
| D0272 |
Bitewings - two radiographic images |
1,150 |
1,142 |
$27K |
| D1351 |
Sealant - per tooth |
758 |
245 |
$22K |
| D2332 |
|
290 |
198 |
$18K |
| D2394 |
|
239 |
195 |
$17K |
| D2330 |
|
481 |
327 |
$17K |
| D5110 |
|
43 |
42 |
$15K |
| D4355 |
|
274 |
269 |
$10K |
| D2740 |
Crown - porcelain/ceramic |
16 |
13 |
$9K |
| D5120 |
|
16 |
15 |
$6K |
| D1206 |
Topical application of fluoride varnish |
149 |
149 |
$4K |
| D2335 |
|
52 |
38 |
$4K |
| D9986 |
|
1,473 |
1,398 |
$0.00 |
| D3120 |
|
28 |
19 |
$0.00 |