| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,386 |
5,809 |
$1.01M |
| D1110 |
Prophylaxis - adult |
17,305 |
16,732 |
$932K |
| D0274 |
Bitewings - four radiographic images |
20,077 |
19,380 |
$730K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
10,876 |
5,037 |
$678K |
| D1120 |
Prophylaxis - child |
12,258 |
11,865 |
$603K |
| D0120 |
Periodic oral evaluation - established patient |
23,323 |
22,611 |
$586K |
| D0220 |
Intraoral - periapical first radiographic image |
33,560 |
31,883 |
$552K |
| D1208 |
Topical application of fluoride, excluding varnish |
17,213 |
16,644 |
$485K |
| D0230 |
Intraoral - periapical each additional radiographic image |
32,293 |
26,305 |
$416K |
| D1351 |
Sealant - per tooth |
10,030 |
3,064 |
$391K |
| D2330 |
|
4,536 |
2,173 |
$319K |
| D0140 |
Limited oral evaluation - problem focused |
7,972 |
7,670 |
$308K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,393 |
6,126 |
$284K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,581 |
1,967 |
$267K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,397 |
1,597 |
$234K |
| D2332 |
|
1,626 |
958 |
$180K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
265 |
181 |
$153K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,764 |
954 |
$148K |
| D0272 |
Bitewings - two radiographic images |
4,947 |
4,819 |
$144K |
| D2740 |
Crown - porcelain/ceramic |
199 |
135 |
$141K |
| D2335 |
|
910 |
504 |
$126K |
| D2950 |
|
408 |
268 |
$64K |
| D2394 |
|
454 |
309 |
$53K |
| D2160 |
|
214 |
158 |
$19K |
| D2331 |
|
187 |
113 |
$16K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
95 |
57 |
$13K |
| D2140 |
|
124 |
67 |
$8K |
| D7111 |
|
23 |
13 |
$2K |
| D1999 |
|
14,815 |
12,232 |
$0.00 |