| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,122 |
1,722 |
$350K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,820 |
1,626 |
$344K |
| D1110 |
Prophylaxis - adult |
5,004 |
4,805 |
$237K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,576 |
1,225 |
$212K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,366 |
1,300 |
$177K |
| D2331 |
|
1,766 |
755 |
$134K |
| D2330 |
|
2,065 |
621 |
$106K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,989 |
5,756 |
$106K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,817 |
2,686 |
$104K |
| D0210 |
Intraoral - complete series of radiographic images |
1,606 |
1,482 |
$88K |
| D0120 |
Periodic oral evaluation - established patient |
3,241 |
3,137 |
$87K |
| D0140 |
Limited oral evaluation - problem focused |
3,170 |
2,964 |
$83K |
| D0220 |
Intraoral - periapical first radiographic image |
6,980 |
6,644 |
$59K |
| D0274 |
Bitewings - four radiographic images |
4,496 |
4,388 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
23,383 |
5,713 |
$44K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
515 |
156 |
$24K |
| D1351 |
Sealant - per tooth |
852 |
148 |
$17K |
| D1120 |
Prophylaxis - child |
695 |
680 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
114 |
85 |
$13K |
| D4341 |
|
243 |
54 |
$10K |
| D2332 |
|
38 |
29 |
$5K |
| D2160 |
|
16 |
12 |
$923.58 |