| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,694 |
1,547 |
$278K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,260 |
594 |
$134K |
| D0120 |
Periodic oral evaluation - established patient |
5,513 |
5,307 |
$133K |
| D1110 |
Prophylaxis - adult |
3,273 |
3,170 |
$121K |
| D0330 |
Panoramic radiographic image |
1,901 |
1,815 |
$107K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,361 |
885 |
$105K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,280 |
4,203 |
$101K |
| D0220 |
Intraoral - periapical first radiographic image |
5,732 |
5,366 |
$82K |
| D0274 |
Bitewings - four radiographic images |
2,443 |
2,347 |
$73K |
| D1120 |
Prophylaxis - child |
2,755 |
2,656 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,556 |
1,485 |
$64K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,133 |
3,024 |
$51K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
331 |
221 |
$41K |
| D1351 |
Sealant - per tooth |
1,224 |
322 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
924 |
869 |
$32K |
| D4355 |
|
337 |
326 |
$22K |
| D0272 |
Bitewings - two radiographic images |
943 |
909 |
$17K |
| D1206 |
Topical application of fluoride varnish |
625 |
599 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
105 |
51 |
$6K |