| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,991 |
1,383 |
$203K |
| D1110 |
Prophylaxis - adult |
5,153 |
5,074 |
$190K |
| D0120 |
Periodic oral evaluation - established patient |
6,367 |
6,280 |
$154K |
| D0274 |
Bitewings - four radiographic images |
2,567 |
2,523 |
$79K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,013 |
758 |
$79K |
| D0220 |
Intraoral - periapical first radiographic image |
5,141 |
4,979 |
$74K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,475 |
3,950 |
$67K |
| D0330 |
Panoramic radiographic image |
967 |
956 |
$55K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,947 |
2,903 |
$48K |
| D1120 |
Prophylaxis - child |
1,576 |
1,569 |
$43K |
| D7140 |
Extraction, erupted tooth or exposed root |
545 |
300 |
$33K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
237 |
194 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
816 |
803 |
$27K |
| D1206 |
Topical application of fluoride varnish |
1,462 |
1,446 |
$23K |
| D1351 |
Sealant - per tooth |
556 |
214 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
357 |
356 |
$15K |
| D0272 |
Bitewings - two radiographic images |
733 |
731 |
$13K |
| D2331 |
|
19 |
14 |
$1K |