| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,299 |
2,701 |
$562K |
| D0120 |
Periodic oral evaluation - established patient |
13,578 |
13,372 |
$353K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,045 |
2,321 |
$324K |
| D1120 |
Prophylaxis - child |
10,274 |
10,096 |
$282K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,079 |
11,881 |
$202K |
| D1110 |
Prophylaxis - adult |
4,724 |
4,655 |
$179K |
| D1351 |
Sealant - per tooth |
6,031 |
1,662 |
$161K |
| D0220 |
Intraoral - periapical first radiographic image |
7,571 |
7,409 |
$114K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,257 |
6,597 |
$112K |
| D0274 |
Bitewings - four radiographic images |
2,834 |
2,776 |
$87K |
| D0272 |
Bitewings - two radiographic images |
4,712 |
4,635 |
$86K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,442 |
1,392 |
$62K |
| D0330 |
Panoramic radiographic image |
915 |
893 |
$48K |
| D0140 |
Limited oral evaluation - problem focused |
1,087 |
1,045 |
$39K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
280 |
201 |
$36K |
| D1206 |
Topical application of fluoride varnish |
756 |
743 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
40 |
30 |
$2K |
| D1999 |
|
2,757 |
2,557 |
$0.00 |