| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,723 |
1,814 |
$212K |
| D1120 |
Prophylaxis - child |
6,964 |
6,526 |
$182K |
| D0120 |
Periodic oral evaluation - established patient |
10,465 |
9,735 |
$181K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,704 |
11,787 |
$171K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,056 |
1,385 |
$130K |
| D1110 |
Prophylaxis - adult |
2,906 |
2,717 |
$99K |
| D0330 |
Panoramic radiographic image |
1,890 |
1,838 |
$90K |
| D1999 |
|
4,023 |
3,300 |
$71K |
| D0272 |
Bitewings - two radiographic images |
2,930 |
2,778 |
$50K |
| D1351 |
Sealant - per tooth |
1,409 |
453 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,468 |
1,379 |
$33K |
| D0145 |
Oral evaluation for a patient under three years of age |
760 |
719 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
478 |
445 |
$12K |
| D1354 |
|
91 |
26 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
130 |
124 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
53 |
40 |
$928.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
14 |
12 |
$890.40 |