| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,156 |
709 |
$110K |
| D0120 |
Periodic oral evaluation - established patient |
4,503 |
4,244 |
$104K |
| D1110 |
Prophylaxis - adult |
2,739 |
2,571 |
$94K |
| D1206 |
Topical application of fluoride varnish |
3,763 |
3,544 |
$55K |
| D0330 |
Panoramic radiographic image |
955 |
895 |
$47K |
| D1120 |
Prophylaxis - child |
1,908 |
1,800 |
$47K |
| D0274 |
Bitewings - four radiographic images |
1,457 |
1,372 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
2,845 |
2,615 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,450 |
1,793 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
952 |
853 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
615 |
572 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
223 |
147 |
$14K |
| D0272 |
Bitewings - two radiographic images |
528 |
491 |
$8K |
| D1351 |
Sealant - per tooth |
363 |
83 |
$7K |
| D4355 |
|
85 |
80 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
35 |
14 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
29 |
24 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
15 |
$1K |