| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,865 |
961 |
$196K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,152 |
623 |
$147K |
| D0120 |
Periodic oral evaluation - established patient |
3,046 |
2,957 |
$75K |
| D0330 |
Panoramic radiographic image |
1,173 |
1,129 |
$65K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
822 |
489 |
$64K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,998 |
3,150 |
$59K |
| D0220 |
Intraoral - periapical first radiographic image |
3,735 |
3,569 |
$54K |
| D1110 |
Prophylaxis - adult |
1,465 |
1,418 |
$54K |
| D0274 |
Bitewings - four radiographic images |
1,580 |
1,515 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,068 |
1,017 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,423 |
2,342 |
$39K |
| D1120 |
Prophylaxis - child |
1,427 |
1,390 |
$38K |
| D2394 |
|
111 |
61 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
432 |
418 |
$15K |
| D0272 |
Bitewings - two radiographic images |
695 |
673 |
$13K |
| D4355 |
|
169 |
166 |
$11K |
| D2332 |
|
114 |
65 |
$11K |
| D1351 |
Sealant - per tooth |
401 |
97 |
$11K |
| D2335 |
|
73 |
37 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
104 |
50 |
$7K |
| D2940 |
|
58 |
13 |
$2K |
| D9239 |
|
33 |
29 |
$2K |
| D9612 |
|
18 |
17 |
$1K |
| D9243 |
|
14 |
12 |
$890.63 |