| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,210 |
773 |
$161K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,399 |
836 |
$149K |
| D1120 |
Prophylaxis - child |
2,392 |
2,311 |
$97K |
| D1351 |
Sealant - per tooth |
2,728 |
931 |
$94K |
| D0330 |
Panoramic radiographic image |
1,177 |
1,134 |
$88K |
| D0120 |
Periodic oral evaluation - established patient |
2,533 |
2,463 |
$85K |
| D1206 |
Topical application of fluoride varnish |
3,260 |
3,165 |
$79K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,921 |
1,946 |
$75K |
| D1110 |
Prophylaxis - adult |
1,297 |
1,266 |
$72K |
| D0274 |
Bitewings - four radiographic images |
1,628 |
1,586 |
$66K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
943 |
900 |
$48K |
| D7140 |
Extraction, erupted tooth or exposed root |
552 |
299 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
2,395 |
2,333 |
$44K |
| D0272 |
Bitewings - two radiographic images |
1,295 |
1,260 |
$41K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
114 |
93 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
152 |
149 |
$8K |
| D2331 |
|
51 |
37 |
$6K |
| D2330 |
|
42 |
29 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
146 |
146 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
119 |
91 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
188 |
146 |
$4K |