| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,825 |
2,209 |
$500K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,163 |
1,232 |
$274K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,629 |
948 |
$128K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,837 |
828 |
$116K |
| D0120 |
Periodic oral evaluation - established patient |
4,673 |
4,560 |
$115K |
| D0330 |
Panoramic radiographic image |
2,014 |
1,926 |
$111K |
| D1110 |
Prophylaxis - adult |
2,867 |
2,785 |
$108K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,989 |
4,347 |
$104K |
| D0220 |
Intraoral - periapical first radiographic image |
5,334 |
5,000 |
$79K |
| D0274 |
Bitewings - four radiographic images |
2,604 |
2,515 |
$77K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,766 |
1,686 |
$75K |
| D1120 |
Prophylaxis - child |
2,361 |
2,303 |
$64K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,423 |
3,334 |
$57K |
| D0140 |
Limited oral evaluation - problem focused |
823 |
781 |
$29K |
| D2332 |
|
258 |
153 |
$25K |
| D2331 |
|
250 |
154 |
$20K |
| D1351 |
Sealant - per tooth |
359 |
76 |
$10K |
| D0272 |
Bitewings - two radiographic images |
546 |
530 |
$10K |
| D2394 |
|
75 |
47 |
$10K |
| D2335 |
|
41 |
26 |
$5K |
| D4355 |
|
19 |
17 |
$1K |
| D4346 |
|
12 |
12 |
$402.13 |