| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,927 |
1,523 |
$290K |
| D0120 |
Periodic oral evaluation - established patient |
8,408 |
7,913 |
$197K |
| D0330 |
Panoramic radiographic image |
3,521 |
3,321 |
$179K |
| D0274 |
Bitewings - four radiographic images |
5,229 |
4,912 |
$157K |
| D0220 |
Intraoral - periapical first radiographic image |
10,430 |
9,660 |
$149K |
| D1110 |
Prophylaxis - adult |
3,855 |
3,653 |
$136K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,852 |
937 |
$108K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,127 |
7,279 |
$103K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
793 |
498 |
$93K |
| D0140 |
Limited oral evaluation - problem focused |
2,546 |
2,424 |
$88K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,994 |
1,896 |
$76K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
974 |
496 |
$67K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,805 |
3,542 |
$59K |
| D4355 |
|
801 |
759 |
$48K |
| D1120 |
Prophylaxis - child |
1,541 |
1,468 |
$39K |
| D1351 |
Sealant - per tooth |
1,714 |
316 |
$37K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
301 |
185 |
$27K |
| D0160 |
|
385 |
352 |
$24K |
| D0272 |
Bitewings - two radiographic images |
715 |
675 |
$12K |
| D2335 |
|
73 |
32 |
$7K |
| D2394 |
|
24 |
14 |
$3K |
| D7311 |
|
24 |
22 |
$2K |
| D7310 |
|
23 |
12 |
$2K |