| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,521 |
4,257 |
$792K |
| D1110 |
Prophylaxis - adult |
10,261 |
8,941 |
$477K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,105 |
2,347 |
$452K |
| D0120 |
Periodic oral evaluation - established patient |
15,481 |
14,248 |
$425K |
| D1120 |
Prophylaxis - child |
7,548 |
7,501 |
$276K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,464 |
9,376 |
$200K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,075 |
3,558 |
$184K |
| D0272 |
Bitewings - two radiographic images |
7,271 |
7,196 |
$149K |
| D0210 |
Intraoral - complete series of radiographic images |
2,564 |
2,127 |
$138K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
689 |
469 |
$43K |
| D0274 |
Bitewings - four radiographic images |
1,406 |
1,041 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
3,036 |
2,691 |
$32K |
| D1351 |
Sealant - per tooth |
513 |
160 |
$17K |
| D2394 |
|
138 |
93 |
$16K |
| D1206 |
Topical application of fluoride varnish |
462 |
461 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,155 |
836 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
125 |
66 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
66 |
39 |
$9K |
| D4341 |
|
73 |
24 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
42 |
37 |
$534.98 |