| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16,148 |
6,874 |
$986K |
| D7140 |
Extraction, erupted tooth or exposed root |
8,979 |
2,480 |
$585K |
| D1110 |
Prophylaxis - adult |
11,347 |
10,789 |
$457K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
6,265 |
3,615 |
$444K |
| D0210 |
Intraoral - complete series of radiographic images |
6,215 |
5,915 |
$425K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,616 |
3,349 |
$420K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
13,405 |
12,708 |
$399K |
| D0274 |
Bitewings - four radiographic images |
13,492 |
12,838 |
$316K |
| D2335 |
|
2,841 |
1,244 |
$269K |
| D2332 |
|
3,438 |
1,813 |
$268K |
| D0120 |
Periodic oral evaluation - established patient |
13,486 |
12,868 |
$268K |
| D0230 |
Intraoral - periapical each additional radiographic image |
35,784 |
14,501 |
$263K |
| D1351 |
Sealant - per tooth |
9,014 |
1,896 |
$232K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,522 |
9,998 |
$181K |
| D1120 |
Prophylaxis - child |
6,729 |
6,385 |
$148K |
| D2331 |
|
2,022 |
1,010 |
$143K |
| D2394 |
|
1,833 |
1,051 |
$138K |
| D0220 |
Intraoral - periapical first radiographic image |
16,926 |
16,027 |
$100K |
| D2330 |
|
1,365 |
684 |
$96K |
| D0330 |
Panoramic radiographic image |
1,194 |
1,147 |
$59K |
| D1320 |
|
1,755 |
1,650 |
$46K |
| D7240 |
Removal of impacted tooth - completely bony |
236 |
73 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
1,557 |
1,482 |
$39K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
728 |
298 |
$39K |
| D0272 |
Bitewings - two radiographic images |
3,337 |
3,173 |
$35K |
| D0240 |
|
2,853 |
1,284 |
$31K |
| D9243 |
|
729 |
184 |
$31K |
| D9944 |
|
65 |
60 |
$25K |
| D9239 |
|
227 |
203 |
$15K |
| D2740 |
Crown - porcelain/ceramic |
16 |
14 |
$13K |
| D2160 |
|
190 |
113 |
$12K |
| D9610 |
|
242 |
220 |
$7K |
| D2161 |
|
81 |
51 |
$6K |
| D4341 |
|
40 |
12 |
$6K |
| D2140 |
|
99 |
50 |
$4K |