| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,530 |
3,442 |
$702K |
| D1110 |
Prophylaxis - adult |
13,439 |
11,186 |
$576K |
| D0120 |
Periodic oral evaluation - established patient |
16,227 |
14,345 |
$416K |
| D0210 |
Intraoral - complete series of radiographic images |
5,569 |
4,515 |
$283K |
| D1120 |
Prophylaxis - child |
8,237 |
7,854 |
$282K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,852 |
5,602 |
$280K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,595 |
1,220 |
$217K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,532 |
9,941 |
$205K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,880 |
995 |
$168K |
| D0220 |
Intraoral - periapical first radiographic image |
9,002 |
7,522 |
$114K |
| D0272 |
Bitewings - two radiographic images |
4,551 |
4,333 |
$95K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,322 |
768 |
$83K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
615 |
228 |
$72K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,691 |
3,392 |
$43K |
| D7140 |
Extraction, erupted tooth or exposed root |
621 |
297 |
$43K |
| D1206 |
Topical application of fluoride varnish |
1,502 |
1,480 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
1,969 |
1,650 |
$35K |
| D1351 |
Sealant - per tooth |
1,128 |
402 |
$32K |
| D0330 |
Panoramic radiographic image |
405 |
393 |
$21K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
123 |
56 |
$11K |
| D0274 |
Bitewings - four radiographic images |
308 |
245 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
180 |
180 |
$7K |
| D9243 |
|
46 |
25 |
$5K |
| D9239 |
|
26 |
25 |
$3K |
| D2140 |
|
20 |
12 |
$1K |