| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,723 |
4,049 |
$344K |
| D1351 |
Sealant - per tooth |
9,586 |
3,314 |
$294K |
| D1120 |
Prophylaxis - child |
7,696 |
7,693 |
$237K |
| D0120 |
Periodic oral evaluation - established patient |
9,695 |
9,695 |
$198K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,320 |
2,701 |
$164K |
| D0274 |
Bitewings - four radiographic images |
9,624 |
9,624 |
$143K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,581 |
9,581 |
$97K |
| D1110 |
Prophylaxis - adult |
2,221 |
2,221 |
$69K |
| D9920 |
|
3,189 |
2,880 |
$48K |
| D0240 |
|
2,493 |
2,393 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
7,620 |
7,537 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
1,696 |
1,672 |
$33K |
| D7140 |
Extraction, erupted tooth or exposed root |
484 |
323 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,648 |
6,644 |
$21K |
| D1206 |
Topical application of fluoride varnish |
1,383 |
1,317 |
$19K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
289 |
259 |
$19K |
| D0330 |
Panoramic radiographic image |
503 |
503 |
$13K |
| D1320 |
|
1,226 |
1,226 |
$12K |
| D2332 |
|
126 |
107 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
66 |
63 |
$4K |
| D2331 |
|
28 |
25 |
$2K |
| D9310 |
|
47 |
47 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
40 |
40 |
$408.70 |