| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,663 |
3,635 |
$617K |
| D4355 |
|
5,316 |
5,215 |
$361K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,016 |
1,555 |
$266K |
| D0274 |
Bitewings - four radiographic images |
5,756 |
5,627 |
$188K |
| D0330 |
Panoramic radiographic image |
3,162 |
3,071 |
$185K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,216 |
1,752 |
$182K |
| D0120 |
Periodic oral evaluation - established patient |
7,106 |
7,044 |
$182K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,793 |
7,360 |
$182K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,943 |
3,826 |
$170K |
| D1110 |
Prophylaxis - adult |
4,290 |
4,241 |
$169K |
| D0220 |
Intraoral - periapical first radiographic image |
8,359 |
8,141 |
$128K |
| D1206 |
Topical application of fluoride varnish |
6,475 |
6,401 |
$106K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
883 |
446 |
$99K |
| D0140 |
Limited oral evaluation - problem focused |
1,860 |
1,794 |
$66K |
| D1351 |
Sealant - per tooth |
1,783 |
550 |
$51K |
| D2331 |
|
542 |
385 |
$46K |
| D2332 |
|
244 |
177 |
$24K |
| D1120 |
Prophylaxis - child |
714 |
708 |
$20K |
| D0272 |
Bitewings - two radiographic images |
537 |
532 |
$10K |
| D4341 |
|
91 |
40 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
124 |
119 |
$9K |
| D2335 |
|
34 |
27 |
$4K |
| D2330 |
|
52 |
40 |
$4K |