| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,952 |
2,409 |
$264K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,437 |
1,902 |
$162K |
| D1110 |
Prophylaxis - adult |
3,671 |
3,652 |
$160K |
| D0120 |
Periodic oral evaluation - established patient |
3,634 |
3,615 |
$104K |
| D0140 |
Limited oral evaluation - problem focused |
3,587 |
3,505 |
$83K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,604 |
4,573 |
$76K |
| D0220 |
Intraoral - periapical first radiographic image |
7,650 |
7,410 |
$65K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
537 |
451 |
$54K |
| D0274 |
Bitewings - four radiographic images |
3,987 |
3,957 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,363 |
1,349 |
$36K |
| D2331 |
|
370 |
272 |
$30K |
| D1999 |
|
1,061 |
978 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,849 |
4,779 |
$12K |
| D1120 |
Prophylaxis - child |
327 |
324 |
$7K |
| D0330 |
Panoramic radiographic image |
256 |
253 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
32 |
26 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
51 |
27 |
$2K |
| D2330 |
|
36 |
28 |
$2K |
| D1351 |
Sealant - per tooth |
54 |
12 |
$1K |
| D9110 |
|
13 |
13 |
$550.72 |
| D0270 |
|
12 |
12 |
$63.12 |
| D2740 |
Crown - porcelain/ceramic |
52 |
39 |
$0.00 |