| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
17,473 |
8,913 |
$1.70M |
| D1351 |
Sealant - per tooth |
72,848 |
16,862 |
$1.65M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19,263 |
9,575 |
$1.41M |
| D1120 |
Prophylaxis - child |
50,091 |
44,291 |
$1.22M |
| D0150 |
Comprehensive oral evaluation - new or established patient |
24,126 |
21,843 |
$966K |
| D1206 |
Topical application of fluoride varnish |
55,053 |
48,535 |
$789K |
| D0120 |
Periodic oral evaluation - established patient |
31,020 |
26,972 |
$705K |
| D0272 |
Bitewings - two radiographic images |
26,891 |
24,437 |
$389K |
| D0220 |
Intraoral - periapical first radiographic image |
20,393 |
19,056 |
$291K |
| D0230 |
Intraoral - periapical each additional radiographic image |
21,557 |
17,441 |
$246K |
| D1110 |
Prophylaxis - adult |
3,233 |
2,713 |
$105K |
| D1354 |
|
12,210 |
3,657 |
$72K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
495 |
361 |
$60K |
| D0274 |
Bitewings - four radiographic images |
1,110 |
1,037 |
$29K |
| D2330 |
|
224 |
157 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
168 |
129 |
$10K |
| D2331 |
|
33 |
25 |
$2K |
| D2332 |
|
17 |
12 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
63 |
63 |
$990.36 |