| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,893 |
1,339 |
$452K |
| D1110 |
Prophylaxis - adult |
1,950 |
1,801 |
$155K |
| D0274 |
Bitewings - four radiographic images |
2,634 |
2,362 |
$138K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,252 |
413 |
$126K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,523 |
1,357 |
$86K |
| D0120 |
Periodic oral evaluation - established patient |
1,803 |
1,650 |
$78K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,769 |
2,545 |
$73K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
497 |
303 |
$63K |
| D1120 |
Prophylaxis - child |
818 |
779 |
$49K |
| D2740 |
Crown - porcelain/ceramic |
67 |
60 |
$45K |
| D0140 |
Limited oral evaluation - problem focused |
803 |
727 |
$45K |
| D1351 |
Sealant - per tooth |
755 |
107 |
$36K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
102 |
56 |
$19K |
| D2331 |
|
93 |
69 |
$12K |
| D4341 |
|
79 |
50 |
$11K |
| D1206 |
Topical application of fluoride varnish |
280 |
275 |
$8K |
| D0272 |
Bitewings - two radiographic images |
115 |
107 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
216 |
176 |
$4K |
| D2950 |
|
22 |
16 |
$3K |
| D0330 |
Panoramic radiographic image |
36 |
29 |
$3K |
| D2330 |
|
20 |
15 |
$2K |