| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,984 |
2,345 |
$453K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,729 |
1,248 |
$247K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,250 |
3,509 |
$140K |
| D1120 |
Prophylaxis - child |
2,320 |
2,267 |
$99K |
| D0120 |
Periodic oral evaluation - established patient |
3,901 |
3,809 |
$98K |
| D0274 |
Bitewings - four radiographic images |
3,096 |
3,036 |
$95K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
825 |
397 |
$94K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,893 |
3,790 |
$84K |
| D1110 |
Prophylaxis - adult |
2,286 |
2,222 |
$75K |
| D2330 |
|
1,249 |
489 |
$67K |
| D0220 |
Intraoral - periapical first radiographic image |
4,939 |
4,196 |
$64K |
| D0140 |
Limited oral evaluation - problem focused |
1,437 |
1,349 |
$40K |
| D2394 |
|
303 |
169 |
$40K |
| D0330 |
Panoramic radiographic image |
931 |
840 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
627 |
611 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
450 |
435 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
296 |
180 |
$22K |
| D1206 |
Topical application of fluoride varnish |
414 |
412 |
$9K |
| D1351 |
Sealant - per tooth |
222 |
80 |
$8K |
| D0272 |
Bitewings - two radiographic images |
176 |
173 |
$5K |