| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,404 |
675 |
$135K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,480 |
494 |
$106K |
| D1110 |
Prophylaxis - adult |
3,078 |
2,909 |
$102K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
771 |
462 |
$90K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,273 |
2,128 |
$88K |
| D0120 |
Periodic oral evaluation - established patient |
3,453 |
3,252 |
$79K |
| D0330 |
Panoramic radiographic image |
2,113 |
1,969 |
$72K |
| D0274 |
Bitewings - four radiographic images |
2,219 |
2,092 |
$55K |
| D1120 |
Prophylaxis - child |
2,186 |
2,073 |
$51K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,363 |
4,133 |
$46K |
| D0140 |
Limited oral evaluation - problem focused |
803 |
741 |
$25K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
298 |
136 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
2,640 |
1,551 |
$23K |
| D0272 |
Bitewings - two radiographic images |
654 |
620 |
$10K |
| D1351 |
Sealant - per tooth |
548 |
59 |
$5K |
| D2394 |
|
17 |
12 |
$3K |
| D1206 |
Topical application of fluoride varnish |
334 |
314 |
$3K |
| D2335 |
|
16 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
131 |
120 |
$1K |
| D1330 |
|
14 |
14 |
$0.00 |