| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,873 |
2,929 |
$869K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,663 |
1,996 |
$606K |
| D1110 |
Prophylaxis - adult |
3,779 |
3,745 |
$238K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,315 |
7,233 |
$170K |
| D0120 |
Periodic oral evaluation - established patient |
5,581 |
5,516 |
$168K |
| D1120 |
Prophylaxis - child |
3,626 |
3,573 |
$159K |
| D0330 |
Panoramic radiographic image |
2,732 |
2,707 |
$122K |
| D0140 |
Limited oral evaluation - problem focused |
2,317 |
2,243 |
$108K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,694 |
1,678 |
$93K |
| D2750 |
|
130 |
88 |
$64K |
| D2331 |
|
251 |
128 |
$28K |
| D0274 |
Bitewings - four radiographic images |
1,130 |
1,127 |
$27K |
| D1330 |
|
3,385 |
3,324 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
119 |
68 |
$15K |
| D0272 |
Bitewings - two radiographic images |
906 |
896 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,176 |
1,146 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
61 |
43 |
$11K |
| D2332 |
|
74 |
43 |
$10K |
| D2330 |
|
66 |
43 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
242 |
238 |
$2K |
| D2950 |
|
16 |
12 |
$1K |