| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,551 |
835 |
$159K |
| D1110 |
Prophylaxis - adult |
2,683 |
2,538 |
$94K |
| D0120 |
Periodic oral evaluation - established patient |
3,234 |
3,099 |
$78K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,687 |
1,611 |
$69K |
| D0220 |
Intraoral - periapical first radiographic image |
4,480 |
4,129 |
$62K |
| D0330 |
Panoramic radiographic image |
1,524 |
1,449 |
$62K |
| D0140 |
Limited oral evaluation - problem focused |
1,808 |
1,671 |
$60K |
| D0274 |
Bitewings - four radiographic images |
2,251 |
2,131 |
$60K |
| D1206 |
Topical application of fluoride varnish |
3,182 |
3,057 |
$47K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,450 |
1,751 |
$39K |
| D1120 |
Prophylaxis - child |
1,338 |
1,300 |
$35K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
232 |
162 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
249 |
173 |
$20K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
130 |
48 |
$11K |
| D1351 |
Sealant - per tooth |
485 |
83 |
$11K |
| D0272 |
Bitewings - two radiographic images |
638 |
616 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
369 |
344 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
54 |
28 |
$3K |
| D0270 |
|
188 |
184 |
$2K |
| D1999 |
|
1,574 |
1,391 |
$0.00 |
| D9986 |
|
273 |
264 |
$0.00 |