| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
972 |
664 |
$135K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,098 |
747 |
$119K |
| D0120 |
Periodic oral evaluation - established patient |
2,345 |
2,271 |
$81K |
| D1120 |
Prophylaxis - child |
1,722 |
1,650 |
$78K |
| D1110 |
Prophylaxis - adult |
1,303 |
1,292 |
$74K |
| D0330 |
Panoramic radiographic image |
963 |
935 |
$71K |
| D1206 |
Topical application of fluoride varnish |
2,660 |
2,576 |
$67K |
| D0274 |
Bitewings - four radiographic images |
1,580 |
1,556 |
$63K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,913 |
1,263 |
$50K |
| D7140 |
Extraction, erupted tooth or exposed root |
545 |
290 |
$43K |
| D1351 |
Sealant - per tooth |
1,015 |
306 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
701 |
690 |
$35K |
| D0272 |
Bitewings - two radiographic images |
979 |
943 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
1,663 |
1,622 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
387 |
367 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
53 |
44 |
$11K |
| D2335 |
|
18 |
12 |
$4K |
| D2332 |
|
20 |
12 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
161 |
103 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
49 |
44 |
$2K |
| D7111 |
|
24 |
16 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
27 |
27 |
$1K |