| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,010 |
789 |
$175K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
808 |
631 |
$104K |
| D1120 |
Prophylaxis - child |
2,168 |
2,120 |
$102K |
| D0120 |
Periodic oral evaluation - established patient |
2,292 |
2,236 |
$93K |
| D1206 |
Topical application of fluoride varnish |
2,809 |
2,742 |
$89K |
| D1351 |
Sealant - per tooth |
1,942 |
572 |
$77K |
| D0330 |
Panoramic radiographic image |
780 |
776 |
$72K |
| D7140 |
Extraction, erupted tooth or exposed root |
573 |
446 |
$70K |
| D0272 |
Bitewings - two radiographic images |
1,656 |
1,620 |
$58K |
| D0140 |
Limited oral evaluation - problem focused |
778 |
750 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
1,353 |
1,300 |
$48K |
| D1110 |
Prophylaxis - adult |
646 |
627 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
675 |
651 |
$43K |
| D0274 |
Bitewings - four radiographic images |
887 |
865 |
$43K |
| D0210 |
Intraoral - complete series of radiographic images |
256 |
222 |
$16K |
| D9110 |
|
181 |
170 |
$14K |
| D0270 |
|
341 |
331 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
88 |
86 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
205 |
184 |
$5K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
14 |
13 |
$4K |
| D7111 |
|
39 |
32 |
$3K |
| D0603 |
|
70 |
70 |
$0.00 |