| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,173 |
652 |
$77K |
| D1110 |
Prophylaxis - adult |
1,931 |
1,916 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
2,015 |
2,004 |
$48K |
| D0274 |
Bitewings - four radiographic images |
1,752 |
1,747 |
$48K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
535 |
376 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
630 |
617 |
$27K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
334 |
215 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
931 |
915 |
$23K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
32 |
27 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
516 |
507 |
$19K |
| D1351 |
Sealant - per tooth |
503 |
71 |
$16K |
| D2331 |
|
151 |
103 |
$10K |
| D1120 |
Prophylaxis - child |
304 |
304 |
$8K |
| D0330 |
Panoramic radiographic image |
189 |
188 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
738 |
730 |
$6K |
| D1206 |
Topical application of fluoride varnish |
324 |
323 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
86 |
39 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
271 |
270 |
$5K |
| D0270 |
|
373 |
368 |
$3K |
| D0272 |
Bitewings - two radiographic images |
163 |
163 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
203 |
202 |
$2K |
| D1330 |
|
216 |
216 |
$2K |
| D1310 |
|
207 |
207 |
$1K |
| D2954 |
|
12 |
12 |
$1K |
| D0601 |
|
18 |
18 |
$110.00 |