| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16,452 |
6,325 |
$2.04M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18,012 |
6,275 |
$1.72M |
| D0120 |
Periodic oral evaluation - established patient |
21,371 |
20,520 |
$625K |
| D1120 |
Prophylaxis - child |
12,917 |
12,363 |
$552K |
| D1110 |
Prophylaxis - adult |
9,073 |
8,751 |
$542K |
| D1208 |
Topical application of fluoride, excluding varnish |
23,107 |
22,200 |
$527K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,994 |
1,064 |
$324K |
| D8670 |
Periodic orthodontic treatment visit |
2,460 |
2,215 |
$181K |
| D0330 |
Panoramic radiographic image |
2,988 |
2,890 |
$128K |
| D0272 |
Bitewings - two radiographic images |
8,298 |
7,974 |
$126K |
| D1330 |
|
12,003 |
11,543 |
$73K |
| D0274 |
Bitewings - four radiographic images |
1,973 |
1,924 |
$46K |
| D1351 |
Sealant - per tooth |
1,305 |
217 |
$41K |
| D1206 |
Topical application of fluoride varnish |
1,556 |
1,453 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
630 |
599 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
227 |
204 |
$10K |
| D8660 |
|
56 |
55 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
58 |
37 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
12 |
$117.00 |