| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2140 |
|
17,216 |
2,017 |
$922K |
| D1110 |
Prophylaxis - adult |
7,216 |
5,752 |
$304K |
| D0120 |
Periodic oral evaluation - established patient |
12,275 |
9,928 |
$289K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,666 |
1,909 |
$273K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,779 |
11,498 |
$262K |
| D1120 |
Prophylaxis - child |
7,241 |
6,370 |
$239K |
| D0272 |
Bitewings - two radiographic images |
7,505 |
5,543 |
$145K |
| D0210 |
Intraoral - complete series of radiographic images |
1,931 |
1,736 |
$124K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,817 |
1,019 |
$114K |
| D2330 |
|
1,179 |
296 |
$72K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,367 |
2,352 |
$68K |
| D0220 |
Intraoral - periapical first radiographic image |
3,838 |
2,428 |
$56K |
| D0330 |
Panoramic radiographic image |
1,190 |
1,185 |
$50K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,097 |
1,718 |
$38K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
399 |
309 |
$35K |
| D0274 |
Bitewings - four radiographic images |
554 |
552 |
$14K |
| D0602 |
|
2,714 |
1,508 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
67 |
51 |
$4K |
| D0603 |
|
1,192 |
877 |
$3K |
| D1206 |
Topical application of fluoride varnish |
138 |
138 |
$3K |
| D7111 |
|
64 |
43 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
23 |
12 |
$2K |
| D0601 |
|
467 |
267 |
$2K |
| D1351 |
Sealant - per tooth |
49 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
24 |
24 |
$556.80 |