| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,455 |
1,476 |
$302K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,686 |
1,387 |
$218K |
| D0330 |
Panoramic radiographic image |
3,248 |
3,110 |
$150K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,099 |
678 |
$118K |
| D1110 |
Prophylaxis - adult |
2,764 |
2,620 |
$96K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,190 |
3,044 |
$85K |
| D0120 |
Periodic oral evaluation - established patient |
3,295 |
3,145 |
$57K |
| D1120 |
Prophylaxis - child |
1,722 |
1,648 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,963 |
1,878 |
$30K |
| D0272 |
Bitewings - two radiographic images |
2,251 |
2,146 |
$23K |
| D1351 |
Sealant - per tooth |
747 |
155 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
181 |
84 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
129 |
77 |
$9K |
| D2140 |
|
151 |
68 |
$6K |
| D2335 |
|
44 |
26 |
$3K |
| D2332 |
|
39 |
12 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
81 |
61 |
$382.96 |