| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,016 |
615 |
$40K |
| D1110 |
Prophylaxis - adult |
1,251 |
1,237 |
$32K |
| D0330 |
Panoramic radiographic image |
1,030 |
1,015 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
814 |
401 |
$30K |
| D0274 |
Bitewings - four radiographic images |
1,525 |
1,506 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
1,335 |
1,327 |
$23K |
| D1351 |
Sealant - per tooth |
1,052 |
216 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,162 |
1,145 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
608 |
400 |
$18K |
| D1206 |
Topical application of fluoride varnish |
1,532 |
1,520 |
$18K |
| D1120 |
Prophylaxis - child |
1,026 |
1,018 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
780 |
759 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,407 |
1,375 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,737 |
1,385 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
147 |
113 |
$7K |
| D1330 |
|
596 |
593 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
55 |
32 |
$6K |
| D0272 |
Bitewings - two radiographic images |
392 |
390 |
$5K |
| D0270 |
|
208 |
203 |
$2K |
| D0240 |
|
30 |
15 |
$0.00 |