| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,767 |
2,104 |
$131K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,023 |
2,068 |
$124K |
| D1110 |
Prophylaxis - adult |
5,125 |
5,103 |
$104K |
| D0210 |
Intraoral - complete series of radiographic images |
3,283 |
3,269 |
$92K |
| D0120 |
Periodic oral evaluation - established patient |
5,217 |
5,208 |
$88K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,556 |
3,544 |
$81K |
| D2335 |
|
1,121 |
671 |
$63K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,566 |
1,065 |
$62K |
| D1120 |
Prophylaxis - child |
2,905 |
2,904 |
$50K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,094 |
4,713 |
$44K |
| D2330 |
|
840 |
545 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,848 |
2,847 |
$30K |
| D2331 |
|
534 |
379 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
5,361 |
5,265 |
$21K |
| D0272 |
Bitewings - two radiographic images |
3,524 |
3,515 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
496 |
325 |
$16K |
| D2160 |
|
334 |
291 |
$15K |
| D2140 |
|
425 |
277 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
285 |
251 |
$13K |
| D9110 |
|
410 |
394 |
$5K |
| D2750 |
|
12 |
12 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
168 |
164 |
$3K |
| D2332 |
|
54 |
40 |
$3K |
| D2954 |
|
13 |
13 |
$585.00 |