| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
14,241 |
7,967 |
$3.35M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
9,852 |
5,758 |
$1.79M |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,066 |
2,795 |
$1.23M |
| D1120 |
Prophylaxis - child |
13,024 |
12,625 |
$693K |
| D1351 |
Sealant - per tooth |
15,161 |
3,789 |
$662K |
| D0120 |
Periodic oral evaluation - established patient |
14,255 |
13,772 |
$578K |
| D1110 |
Prophylaxis - adult |
5,314 |
5,139 |
$376K |
| D9920 |
|
2,358 |
2,146 |
$320K |
| D0274 |
Bitewings - four radiographic images |
6,232 |
6,031 |
$318K |
| D0220 |
Intraoral - periapical first radiographic image |
13,283 |
12,692 |
$316K |
| D0272 |
Bitewings - two radiographic images |
8,114 |
7,850 |
$291K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,197 |
12,086 |
$287K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,610 |
1,110 |
$274K |
| D1206 |
Topical application of fluoride varnish |
7,957 |
7,719 |
$254K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,729 |
3,481 |
$247K |
| D0240 |
|
5,909 |
2,887 |
$177K |
| D2330 |
|
865 |
504 |
$148K |
| D2394 |
|
261 |
214 |
$98K |
| D7111 |
|
547 |
331 |
$61K |
| D0140 |
Limited oral evaluation - problem focused |
901 |
847 |
$54K |
| D2331 |
|
149 |
115 |
$36K |
| D2332 |
|
34 |
25 |
$9K |
| D2950 |
|
16 |
12 |
$5K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
18 |
12 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
16 |
14 |
$2K |
| D2940 |
|
15 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
24 |
23 |
$1K |
| D1999 |
|
4,769 |
3,734 |
$0.00 |
| D0603 |
|
17,328 |
16,676 |
$0.00 |
| D0602 |
|
500 |
480 |
$0.00 |