| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,969 |
2,864 |
$327K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,815 |
2,768 |
$308K |
| D0120 |
Periodic oral evaluation - established patient |
4,096 |
4,081 |
$233K |
| D1120 |
Prophylaxis - child |
4,629 |
4,614 |
$177K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,500 |
1,498 |
$97K |
| D0350 |
|
8,846 |
3,353 |
$85K |
| D9430 |
|
2,886 |
2,190 |
$84K |
| D0210 |
Intraoral - complete series of radiographic images |
1,446 |
1,443 |
$68K |
| D1206 |
Topical application of fluoride varnish |
4,804 |
4,790 |
$61K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,415 |
4,072 |
$60K |
| D1110 |
Prophylaxis - adult |
654 |
654 |
$58K |
| D0274 |
Bitewings - four radiographic images |
2,414 |
2,410 |
$47K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
604 |
436 |
$47K |
| D0330 |
Panoramic radiographic image |
1,205 |
1,200 |
$36K |
| D1351 |
Sealant - per tooth |
288 |
92 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
87 |
50 |
$5K |
| D4341 |
|
66 |
29 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
664 |
651 |
$4K |
| D9993 |
|
25 |
25 |
$2K |
| D2330 |
|
21 |
13 |
$2K |
| D0272 |
Bitewings - two radiographic images |
102 |
102 |
$1K |
| D1310 |
|
25 |
25 |
$1K |
| D1999 |
|
39 |
38 |
$46.00 |