| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,031 |
1,396 |
$297K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,891 |
1,164 |
$288K |
| D2331 |
|
3,334 |
1,004 |
$193K |
| D2330 |
|
1,305 |
671 |
$88K |
| D1120 |
Prophylaxis - child |
2,754 |
2,355 |
$71K |
| D0140 |
Limited oral evaluation - problem focused |
1,342 |
1,221 |
$49K |
| D0330 |
Panoramic radiographic image |
837 |
729 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,659 |
2,267 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
1,447 |
1,350 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,206 |
904 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
397 |
271 |
$18K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
146 |
56 |
$11K |
| D0272 |
Bitewings - two radiographic images |
548 |
436 |
$9K |
| D2335 |
|
563 |
87 |
$3K |
| D1351 |
Sealant - per tooth |
185 |
54 |
$3K |
| D7510 |
|
16 |
16 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
25 |
15 |
$2K |
| D2140 |
|
21 |
12 |
$1K |