| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,683 |
3,114 |
$361K |
| D1120 |
Prophylaxis - child |
6,900 |
6,676 |
$283K |
| D0120 |
Periodic oral evaluation - established patient |
8,738 |
8,430 |
$242K |
| D1351 |
Sealant - per tooth |
2,794 |
1,543 |
$194K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,709 |
6,481 |
$174K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,733 |
1,320 |
$156K |
| D4342 |
|
880 |
494 |
$127K |
| D0274 |
Bitewings - four radiographic images |
7,107 |
6,889 |
$114K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,754 |
1,367 |
$86K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,497 |
3,404 |
$81K |
| D1110 |
Prophylaxis - adult |
1,844 |
1,783 |
$80K |
| D0220 |
Intraoral - periapical first radiographic image |
11,690 |
11,286 |
$72K |
| D4341 |
|
327 |
172 |
$70K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,729 |
10,096 |
$67K |
| D4910 |
|
594 |
590 |
$39K |
| D7140 |
Extraction, erupted tooth or exposed root |
496 |
428 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
969 |
910 |
$26K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
66 |
51 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
987 |
961 |
$17K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
262 |
163 |
$16K |
| D0272 |
Bitewings - two radiographic images |
1,130 |
1,101 |
$11K |
| D2331 |
|
97 |
84 |
$10K |
| D0330 |
Panoramic radiographic image |
294 |
293 |
$8K |
| D2330 |
|
76 |
64 |
$5K |
| D2740 |
Crown - porcelain/ceramic |
16 |
13 |
$4K |
| D2160 |
|
53 |
39 |
$3K |
| D2950 |
|
29 |
25 |
$2K |
| D2332 |
|
15 |
12 |
$2K |
| D1999 |
|
12 |
12 |
$0.00 |