| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
9,504 |
5,012 |
$542K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,707 |
2,624 |
$262K |
| D1110 |
Prophylaxis - adult |
7,003 |
6,655 |
$235K |
| D0210 |
Intraoral - complete series of radiographic images |
3,553 |
3,402 |
$207K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,088 |
4,404 |
$195K |
| D2394 |
|
1,465 |
1,161 |
$175K |
| D0274 |
Bitewings - four radiographic images |
5,730 |
5,523 |
$170K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,298 |
7,975 |
$157K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,396 |
6,046 |
$139K |
| D0120 |
Periodic oral evaluation - established patient |
6,270 |
6,088 |
$138K |
| D1120 |
Prophylaxis - child |
2,860 |
2,845 |
$124K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,124 |
884 |
$103K |
| D0140 |
Limited oral evaluation - problem focused |
2,614 |
2,492 |
$73K |
| D1351 |
Sealant - per tooth |
1,608 |
457 |
$62K |
| D0330 |
Panoramic radiographic image |
1,170 |
1,016 |
$56K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
343 |
203 |
$36K |
| D7250 |
|
257 |
129 |
$32K |
| D2330 |
|
629 |
498 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
304 |
139 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,755 |
1,666 |
$19K |
| D0272 |
Bitewings - two radiographic images |
321 |
321 |
$9K |
| D2954 |
|
51 |
38 |
$6K |