| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
5,955 |
2,134 |
$473K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,846 |
2,327 |
$361K |
| D2332 |
|
3,371 |
1,138 |
$300K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,073 |
1,368 |
$185K |
| D2335 |
|
1,267 |
486 |
$157K |
| D1110 |
Prophylaxis - adult |
3,850 |
3,562 |
$142K |
| D0210 |
Intraoral - complete series of radiographic images |
2,050 |
1,930 |
$128K |
| D9944 |
|
504 |
452 |
$112K |
| D0120 |
Periodic oral evaluation - established patient |
4,896 |
4,485 |
$92K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,475 |
782 |
$89K |
| D1351 |
Sealant - per tooth |
3,511 |
683 |
$82K |
| D0140 |
Limited oral evaluation - problem focused |
2,911 |
2,301 |
$70K |
| D1120 |
Prophylaxis - child |
3,177 |
2,937 |
$69K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,150 |
3,808 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,493 |
2,375 |
$67K |
| D0274 |
Bitewings - four radiographic images |
2,386 |
2,197 |
$52K |
| D0240 |
|
4,638 |
1,526 |
$44K |
| D2394 |
|
348 |
225 |
$36K |
| D1320 |
|
2,151 |
1,893 |
$34K |
| D2931 |
|
205 |
127 |
$27K |
| D2330 |
|
405 |
162 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,728 |
1,592 |
$19K |
| D0470 |
|
589 |
528 |
$14K |
| D0350 |
|
406 |
396 |
$5K |
| D0330 |
Panoramic radiographic image |
68 |
66 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
426 |
423 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
27 |
13 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
94 |
94 |
$470.00 |