| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,933 |
2,000 |
$271K |
| D1110 |
Prophylaxis - adult |
6,461 |
6,446 |
$269K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,462 |
1,819 |
$255K |
| D0120 |
Periodic oral evaluation - established patient |
8,966 |
8,951 |
$215K |
| D1120 |
Prophylaxis - child |
3,876 |
3,875 |
$150K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,032 |
1,546 |
$142K |
| D0210 |
Intraoral - complete series of radiographic images |
2,322 |
2,251 |
$126K |
| D1206 |
Topical application of fluoride varnish |
4,810 |
4,809 |
$117K |
| D0140 |
Limited oral evaluation - problem focused |
4,000 |
3,901 |
$112K |
| D0274 |
Bitewings - four radiographic images |
3,818 |
3,813 |
$110K |
| D2740 |
Crown - porcelain/ceramic |
142 |
97 |
$98K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,291 |
894 |
$88K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
748 |
610 |
$72K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,677 |
1,673 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
4,119 |
4,023 |
$46K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
391 |
295 |
$30K |
| D2331 |
|
415 |
324 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,093 |
1,103 |
$13K |
| D2140 |
|
230 |
184 |
$12K |
| D0272 |
Bitewings - two radiographic images |
468 |
468 |
$11K |
| D2330 |
|
201 |
136 |
$10K |
| D2335 |
|
110 |
80 |
$10K |
| D2160 |
|
124 |
91 |
$10K |
| D1351 |
Sealant - per tooth |
311 |
99 |
$8K |
| D4355 |
|
148 |
147 |
$8K |
| D0191 |
|
313 |
313 |
$6K |
| D0330 |
Panoramic radiographic image |
97 |
97 |
$4K |
| D2332 |
|
39 |
24 |
$3K |
| D2394 |
|
15 |
14 |
$1K |