| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,342 |
2,796 |
$679K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,786 |
2,563 |
$575K |
| D1110 |
Prophylaxis - adult |
7,544 |
7,432 |
$476K |
| D1120 |
Prophylaxis - child |
9,463 |
9,290 |
$411K |
| D1351 |
Sealant - per tooth |
11,648 |
2,352 |
$407K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,099 |
6,979 |
$382K |
| D0120 |
Periodic oral evaluation - established patient |
11,380 |
11,195 |
$340K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,483 |
11,259 |
$262K |
| D0274 |
Bitewings - four radiographic images |
8,619 |
8,462 |
$198K |
| D0220 |
Intraoral - periapical first radiographic image |
16,021 |
15,619 |
$161K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
950 |
502 |
$153K |
| D0140 |
Limited oral evaluation - problem focused |
3,076 |
2,971 |
$141K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,059 |
13,790 |
$124K |
| D7140 |
Extraction, erupted tooth or exposed root |
827 |
399 |
$106K |
| D2335 |
|
443 |
181 |
$67K |
| D2331 |
|
477 |
244 |
$50K |
| D0272 |
Bitewings - two radiographic images |
3,245 |
3,179 |
$49K |
| D2332 |
|
336 |
153 |
$42K |
| D2330 |
|
362 |
189 |
$33K |
| D1206 |
Topical application of fluoride varnish |
954 |
953 |
$24K |
| D1330 |
|
1,808 |
1,808 |
$13K |