| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2394 |
|
1,235 |
795 |
$87K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
831 |
537 |
$48K |
| D1110 |
Prophylaxis - adult |
1,662 |
1,581 |
$45K |
| D0210 |
Intraoral - complete series of radiographic images |
1,127 |
1,075 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
2,769 |
2,651 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,408 |
2,306 |
$31K |
| D1120 |
Prophylaxis - child |
1,373 |
1,313 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
2,421 |
2,282 |
$18K |
| D0272 |
Bitewings - two radiographic images |
1,086 |
1,038 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
286 |
208 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
812 |
772 |
$14K |
| D0274 |
Bitewings - four radiographic images |
799 |
758 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,036 |
1,936 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
473 |
454 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
140 |
86 |
$5K |
| D2335 |
|
35 |
14 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
26 |
13 |
$1K |
| D1351 |
Sealant - per tooth |
50 |
14 |
$845.00 |
| D9110 |
|
26 |
24 |
$583.29 |
| D0170 |
|
12 |
12 |
$231.30 |