| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,242 |
1,864 |
$544K |
| D1110 |
Prophylaxis - adult |
7,656 |
6,294 |
$377K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,075 |
1,254 |
$297K |
| D0210 |
Intraoral - complete series of radiographic images |
3,435 |
2,536 |
$217K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,815 |
3,490 |
$206K |
| D0120 |
Periodic oral evaluation - established patient |
6,474 |
5,614 |
$196K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,701 |
724 |
$195K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
999 |
709 |
$191K |
| D1206 |
Topical application of fluoride varnish |
4,545 |
4,183 |
$130K |
| D0274 |
Bitewings - four radiographic images |
3,086 |
2,698 |
$116K |
| D1120 |
Prophylaxis - child |
2,078 |
1,918 |
$99K |
| D1351 |
Sealant - per tooth |
1,591 |
277 |
$58K |
| D0220 |
Intraoral - periapical first radiographic image |
3,430 |
2,796 |
$58K |
| D0140 |
Limited oral evaluation - problem focused |
1,220 |
988 |
$50K |
| D0330 |
Panoramic radiographic image |
623 |
534 |
$44K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,411 |
1,843 |
$36K |
| D2335 |
|
98 |
68 |
$27K |
| D2394 |
|
123 |
90 |
$27K |
| D2331 |
|
147 |
107 |
$23K |
| D4341 |
|
81 |
37 |
$15K |
| D0272 |
Bitewings - two radiographic images |
297 |
261 |
$9K |
| D4355 |
|
27 |
27 |
$5K |
| D1354 |
|
60 |
14 |
$4K |
| D2332 |
|
17 |
12 |
$3K |
| D0602 |
|
1,583 |
1,433 |
$0.00 |
| D0601 |
|
2,131 |
1,922 |
$0.00 |
| D0603 |
|
652 |
558 |
$0.00 |