| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,882 |
4,839 |
$950K |
| D1120 |
Prophylaxis - child |
16,206 |
15,172 |
$667K |
| D1206 |
Topical application of fluoride varnish |
24,992 |
23,559 |
$589K |
| D1351 |
Sealant - per tooth |
17,911 |
4,578 |
$581K |
| D0120 |
Periodic oral evaluation - established patient |
16,593 |
15,470 |
$461K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,284 |
2,140 |
$310K |
| D1110 |
Prophylaxis - adult |
5,102 |
4,787 |
$291K |
| D0274 |
Bitewings - four radiographic images |
9,403 |
8,855 |
$200K |
| D0330 |
Panoramic radiographic image |
4,150 |
3,854 |
$166K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
918 |
685 |
$139K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,189 |
2,068 |
$111K |
| D0220 |
Intraoral - periapical first radiographic image |
11,426 |
10,501 |
$105K |
| D0272 |
Bitewings - two radiographic images |
6,802 |
6,419 |
$98K |
| D1330 |
|
11,793 |
11,098 |
$69K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,541 |
9,687 |
$64K |
| D0140 |
Limited oral evaluation - problem focused |
1,138 |
1,049 |
$49K |
| D0240 |
|
2,257 |
2,214 |
$40K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,011 |
932 |
$39K |
| D2940 |
|
141 |
113 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
35 |
24 |
$4K |
| D3120 |
|
50 |
49 |
$2K |
| 81025 |
|
22 |
21 |
$143.64 |