| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,367 |
1,352 |
$323K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
996 |
542 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,275 |
1,265 |
$43K |
| D2331 |
|
426 |
185 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,776 |
1,768 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,933 |
1,927 |
$33K |
| D1110 |
Prophylaxis - adult |
714 |
712 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
2,314 |
2,285 |
$26K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
230 |
114 |
$25K |
| D1120 |
Prophylaxis - child |
792 |
788 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,165 |
2,056 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
531 |
525 |
$12K |
| D1351 |
Sealant - per tooth |
544 |
162 |
$12K |
| D4346 |
|
74 |
74 |
$9K |
| D0330 |
Panoramic radiographic image |
405 |
405 |
$9K |
| D2332 |
|
73 |
30 |
$7K |
| D4341 |
|
49 |
13 |
$6K |
| D0274 |
Bitewings - four radiographic images |
93 |
93 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
91 |
90 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
113 |
109 |
$2K |
| D0601 |
|
27 |
27 |
$0.00 |
| D0603 |
|
13 |
13 |
$0.00 |