| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2335 |
|
3,468 |
1,852 |
$275K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,988 |
2,344 |
$271K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,432 |
1,794 |
$244K |
| D1110 |
Prophylaxis - adult |
5,857 |
5,850 |
$184K |
| D0120 |
Periodic oral evaluation - established patient |
7,638 |
7,633 |
$135K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,108 |
5,081 |
$81K |
| D0210 |
Intraoral - complete series of radiographic images |
2,569 |
2,566 |
$72K |
| D0220 |
Intraoral - periapical first radiographic image |
5,169 |
5,163 |
$40K |
| D7140 |
Extraction, erupted tooth or exposed root |
752 |
365 |
$28K |
| D2160 |
|
395 |
222 |
$25K |
| D1120 |
Prophylaxis - child |
881 |
880 |
$24K |
| D1351 |
Sealant - per tooth |
467 |
124 |
$16K |
| D2952 |
|
74 |
39 |
$6K |
| D5761 |
|
37 |
37 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
253 |
252 |
$2K |
| D5760 |
|
12 |
12 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
16 |
13 |
$853.25 |