| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,695 |
1,400 |
$358K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,034 |
1,049 |
$209K |
| D1351 |
Sealant - per tooth |
5,648 |
1,056 |
$196K |
| D1120 |
Prophylaxis - child |
4,369 |
4,313 |
$190K |
| D1110 |
Prophylaxis - adult |
2,830 |
2,785 |
$181K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,790 |
7,697 |
$180K |
| D0120 |
Periodic oral evaluation - established patient |
5,320 |
5,250 |
$161K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,652 |
2,619 |
$143K |
| D0220 |
Intraoral - periapical first radiographic image |
8,225 |
8,008 |
$87K |
| D0274 |
Bitewings - four radiographic images |
3,057 |
3,010 |
$73K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,918 |
6,823 |
$57K |
| D7140 |
Extraction, erupted tooth or exposed root |
352 |
228 |
$45K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
224 |
150 |
$39K |
| D4341 |
|
393 |
147 |
$30K |
| D0272 |
Bitewings - two radiographic images |
1,710 |
1,700 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
428 |
422 |
$20K |
| D2750 |
|
30 |
26 |
$15K |
| D1330 |
|
420 |
420 |
$3K |
| D2950 |
|
25 |
25 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
32 |
32 |
$2K |