| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,159 |
1,251 |
$186K |
| D0120 |
Periodic oral evaluation - established patient |
6,948 |
6,696 |
$157K |
| D1110 |
Prophylaxis - adult |
4,252 |
4,157 |
$146K |
| D0210 |
Intraoral - complete series of radiographic images |
2,476 |
2,426 |
$146K |
| D5640 |
|
2,157 |
903 |
$145K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,444 |
6,370 |
$133K |
| D1120 |
Prophylaxis - child |
2,598 |
2,563 |
$114K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,679 |
974 |
$103K |
| D0140 |
Limited oral evaluation - problem focused |
3,301 |
3,217 |
$87K |
| D0274 |
Bitewings - four radiographic images |
2,305 |
2,291 |
$74K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,088 |
722 |
$69K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
660 |
520 |
$65K |
| D5611 |
|
796 |
747 |
$64K |
| D5650 |
|
1,105 |
564 |
$54K |
| D5630 |
|
633 |
602 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
1,828 |
1,789 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
227 |
219 |
$10K |
| D2335 |
|
59 |
41 |
$6K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
14 |
12 |
$6K |
| D2954 |
|
43 |
29 |
$6K |
| D2140 |
|
115 |
83 |
$6K |
| D2331 |
|
77 |
54 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
92 |
67 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
365 |
211 |
$4K |
| D1351 |
Sealant - per tooth |
47 |
14 |
$2K |
| D2394 |
|
12 |
12 |
$1K |
| D2160 |
|
16 |
12 |
$980.20 |
| D2330 |
|
14 |
12 |
$728.00 |
| D0272 |
Bitewings - two radiographic images |
29 |
28 |
$640.64 |