| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,062 |
1,147 |
$272K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,499 |
810 |
$151K |
| D1120 |
Prophylaxis - child |
2,846 |
2,808 |
$128K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,326 |
2,301 |
$126K |
| D1110 |
Prophylaxis - adult |
1,766 |
1,753 |
$115K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,858 |
4,803 |
$113K |
| D1351 |
Sealant - per tooth |
3,041 |
656 |
$104K |
| D0120 |
Periodic oral evaluation - established patient |
2,763 |
2,728 |
$85K |
| D0220 |
Intraoral - periapical first radiographic image |
5,360 |
5,246 |
$57K |
| D0274 |
Bitewings - four radiographic images |
2,110 |
2,085 |
$50K |
| D7140 |
Extraction, erupted tooth or exposed root |
353 |
159 |
$44K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
232 |
123 |
$40K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,539 |
4,487 |
$38K |
| D4341 |
|
351 |
155 |
$30K |
| D0272 |
Bitewings - two radiographic images |
929 |
919 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
297 |
296 |
$14K |
| D1330 |
|
826 |
822 |
$5K |
| D2950 |
|
13 |
12 |
$1K |