| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,048 |
973 |
$254K |
| D1120 |
Prophylaxis - child |
3,856 |
3,772 |
$170K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,039 |
491 |
$170K |
| D0120 |
Periodic oral evaluation - established patient |
4,970 |
4,860 |
$148K |
| D1110 |
Prophylaxis - adult |
1,941 |
1,895 |
$117K |
| D1206 |
Topical application of fluoride varnish |
4,077 |
3,991 |
$101K |
| D1351 |
Sealant - per tooth |
2,286 |
443 |
$75K |
| D0274 |
Bitewings - four radiographic images |
2,823 |
2,753 |
$63K |
| D0220 |
Intraoral - periapical first radiographic image |
5,280 |
5,140 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,563 |
1,521 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,959 |
4,842 |
$31K |
| D0272 |
Bitewings - two radiographic images |
1,877 |
1,839 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
230 |
143 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
371 |
363 |
$19K |
| D1330 |
|
1,382 |
1,351 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
161 |
160 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
37 |
24 |
$4K |
| D0330 |
Panoramic radiographic image |
48 |
43 |
$2K |