| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,877 |
939 |
$251K |
| D2750 |
|
469 |
403 |
$223K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,457 |
713 |
$148K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
556 |
310 |
$96K |
| D1110 |
Prophylaxis - adult |
1,391 |
1,377 |
$91K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,602 |
1,573 |
$89K |
| D0330 |
Panoramic radiographic image |
1,420 |
1,393 |
$64K |
| D4341 |
|
605 |
224 |
$52K |
| D0140 |
Limited oral evaluation - problem focused |
947 |
867 |
$44K |
| D1206 |
Topical application of fluoride varnish |
1,676 |
1,655 |
$43K |
| D2950 |
|
459 |
396 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,388 |
1,365 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
692 |
691 |
$22K |
| D1120 |
Prophylaxis - child |
453 |
444 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
144 |
87 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,096 |
1,041 |
$13K |
| D1351 |
Sealant - per tooth |
294 |
43 |
$12K |
| D3320 |
|
18 |
13 |
$12K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$9K |
| D3120 |
|
263 |
181 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
232 |
232 |
$6K |
| D2330 |
|
44 |
25 |
$4K |
| D2332 |
|
26 |
15 |
$4K |
| D0272 |
Bitewings - two radiographic images |
198 |
198 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
273 |
270 |
$3K |
| D1330 |
|
155 |
155 |
$1K |