| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
500 |
263 |
$49K |
| D1110 |
Prophylaxis - adult |
2,604 |
2,496 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
877 |
744 |
$41K |
| D0140 |
Limited oral evaluation - problem focused |
1,088 |
969 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
537 |
223 |
$35K |
| D4341 |
|
470 |
194 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
457 |
365 |
$30K |
| D4910 |
|
612 |
590 |
$26K |
| D1206 |
Topical application of fluoride varnish |
3,187 |
2,993 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
2,654 |
2,487 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
169 |
106 |
$18K |
| D0274 |
Bitewings - four radiographic images |
670 |
616 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
640 |
587 |
$16K |
| D4342 |
|
170 |
67 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,800 |
1,203 |
$13K |
| D1120 |
Prophylaxis - child |
738 |
685 |
$11K |
| D9310 |
|
601 |
598 |
$5K |
| D2332 |
|
33 |
12 |
$3K |
| D1351 |
Sealant - per tooth |
237 |
104 |
$628.00 |
| D0191 |
|
182 |
182 |
$522.00 |
| D0240 |
|
38 |
14 |
$351.71 |
| D0180 |
|
39 |
39 |
$294.00 |
| D0601 |
|
103 |
102 |
$121.00 |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$104.00 |
| D0272 |
Bitewings - two radiographic images |
19 |
19 |
$100.00 |
| D0602 |
|
26 |
26 |
$55.00 |
| D1330 |
|
1,053 |
986 |
$40.00 |
| D1310 |
|
171 |
116 |
$0.00 |
| D9986 |
|
863 |
843 |
$0.00 |