| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,790 |
2,413 |
$817K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,170 |
1,247 |
$211K |
| D1351 |
Sealant - per tooth |
6,184 |
1,202 |
$132K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,766 |
3,152 |
$109K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,525 |
3,064 |
$91K |
| D1120 |
Prophylaxis - child |
2,708 |
2,243 |
$80K |
| D1110 |
Prophylaxis - adult |
1,046 |
901 |
$48K |
| D0274 |
Bitewings - four radiographic images |
1,906 |
1,602 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,795 |
3,179 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
3,684 |
3,062 |
$31K |
| D0145 |
Oral evaluation for a patient under three years of age |
159 |
156 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
216 |
211 |
$13K |
| D0330 |
Panoramic radiographic image |
536 |
499 |
$11K |
| D1330 |
|
3,612 |
3,027 |
$5K |
| D2330 |
|
23 |
17 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
39 |
16 |
$1K |
| D0272 |
Bitewings - two radiographic images |
124 |
53 |
$1K |
| D0602 |
|
3,940 |
3,317 |
$0.00 |
| D0603 |
|
55 |
53 |
$0.00 |