| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2394 |
|
3,324 |
1,448 |
$115K |
| D1120 |
Prophylaxis - child |
6,545 |
6,503 |
$66K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,265 |
1,293 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,619 |
4,588 |
$52K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,862 |
1,276 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,942 |
7,884 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
7,881 |
7,818 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,838 |
811 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,471 |
7,633 |
$24K |
| D0274 |
Bitewings - four radiographic images |
3,223 |
3,203 |
$24K |
| D2335 |
|
534 |
259 |
$15K |
| D0272 |
Bitewings - two radiographic images |
2,881 |
2,860 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
2,524 |
2,512 |
$13K |
| D1110 |
Prophylaxis - adult |
1,210 |
1,199 |
$13K |
| D1351 |
Sealant - per tooth |
2,262 |
601 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
339 |
126 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
431 |
428 |
$3K |
| D2332 |
|
67 |
44 |
$1K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
24 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
64 |
63 |
$227.32 |