| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,541 |
1,510 |
$298K |
| D0274 |
Bitewings - four radiographic images |
6,378 |
6,201 |
$214K |
| D0330 |
Panoramic radiographic image |
3,129 |
3,005 |
$183K |
| D1120 |
Prophylaxis - child |
4,055 |
3,999 |
$178K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,897 |
7,725 |
$174K |
| D0120 |
Periodic oral evaluation - established patient |
5,964 |
5,846 |
$159K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,234 |
989 |
$157K |
| D1110 |
Prophylaxis - adult |
3,496 |
3,381 |
$121K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,621 |
2,213 |
$102K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
776 |
422 |
$87K |
| D0140 |
Limited oral evaluation - problem focused |
2,924 |
2,706 |
$84K |
| D1351 |
Sealant - per tooth |
1,471 |
383 |
$56K |
| D0220 |
Intraoral - periapical first radiographic image |
2,650 |
2,510 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
940 |
601 |
$10K |
| D2394 |
|
38 |
26 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
72 |
40 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
17 |
13 |
$2K |