| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
986 |
307 |
$98K |
| D0140 |
Limited oral evaluation - problem focused |
1,170 |
887 |
$54K |
| D2332 |
|
328 |
119 |
$43K |
| D1110 |
Prophylaxis - adult |
335 |
327 |
$21K |
| D0330 |
Panoramic radiographic image |
452 |
442 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
570 |
558 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
610 |
598 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
90 |
30 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
358 |
326 |
$13K |
| D1120 |
Prophylaxis - child |
268 |
263 |
$12K |
| D9248 |
|
58 |
53 |
$11K |
| D0274 |
Bitewings - four radiographic images |
398 |
390 |
$9K |
| D1351 |
Sealant - per tooth |
267 |
52 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
57 |
28 |
$6K |
| D0272 |
Bitewings - two radiographic images |
242 |
237 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
360 |
328 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
49 |
49 |
$3K |
| D1330 |
|
297 |
293 |
$2K |
| D3120 |
|
44 |
29 |
$2K |