| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,720 |
2,958 |
$473K |
| D0120 |
Periodic oral evaluation - established patient |
14,046 |
13,253 |
$336K |
| D1110 |
Prophylaxis - adult |
8,839 |
8,278 |
$311K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,819 |
1,927 |
$214K |
| D0330 |
Panoramic radiographic image |
4,201 |
3,828 |
$198K |
| D1120 |
Prophylaxis - child |
7,588 |
7,048 |
$191K |
| D0274 |
Bitewings - four radiographic images |
6,196 |
5,701 |
$174K |
| D0220 |
Intraoral - periapical first radiographic image |
12,032 |
11,201 |
$168K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,166 |
8,451 |
$139K |
| D0140 |
Limited oral evaluation - problem focused |
4,129 |
3,848 |
$137K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,663 |
3,240 |
$134K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,058 |
7,951 |
$126K |
| D1206 |
Topical application of fluoride varnish |
3,153 |
3,053 |
$51K |
| D7140 |
Extraction, erupted tooth or exposed root |
846 |
328 |
$47K |
| D0272 |
Bitewings - two radiographic images |
2,130 |
1,976 |
$35K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
303 |
192 |
$33K |
| D1351 |
Sealant - per tooth |
461 |
107 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
81 |
52 |
$8K |
| D2335 |
|
14 |
12 |
$2K |
| D2331 |
|
20 |
12 |
$2K |
| D2330 |
|
17 |
12 |
$1K |