| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,276 |
3,094 |
$526K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,237 |
2,792 |
$393K |
| D0120 |
Periodic oral evaluation - established patient |
12,774 |
11,970 |
$310K |
| D1110 |
Prophylaxis - adult |
7,565 |
7,045 |
$272K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,024 |
1,363 |
$246K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,221 |
1,075 |
$223K |
| D1120 |
Prophylaxis - child |
8,212 |
7,709 |
$214K |
| D1351 |
Sealant - per tooth |
7,934 |
1,869 |
$204K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,633 |
4,250 |
$187K |
| D0330 |
Panoramic radiographic image |
3,742 |
3,406 |
$186K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,470 |
10,735 |
$182K |
| D0274 |
Bitewings - four radiographic images |
5,301 |
4,873 |
$155K |
| D0220 |
Intraoral - periapical first radiographic image |
7,981 |
7,272 |
$111K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,534 |
5,652 |
$83K |
| D0140 |
Limited oral evaluation - problem focused |
1,857 |
1,713 |
$62K |
| D0272 |
Bitewings - two radiographic images |
3,380 |
3,147 |
$57K |
| D7140 |
Extraction, erupted tooth or exposed root |
268 |
92 |
$15K |
| D1206 |
Topical application of fluoride varnish |
730 |
693 |
$12K |
| D4355 |
|
140 |
137 |
$9K |
| D2330 |
|
74 |
39 |
$3K |
| D2335 |
|
17 |
12 |
$2K |
| D4341 |
|
26 |
12 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
1,202 |
1,118 |
$0.00 |
| D1999 |
|
408 |
360 |
$0.00 |