| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,367 |
748 |
$78K |
| D1110 |
Prophylaxis - adult |
1,160 |
1,147 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
1,504 |
1,491 |
$36K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
474 |
391 |
$29K |
| D1351 |
Sealant - per tooth |
952 |
268 |
$28K |
| D2330 |
|
432 |
261 |
$24K |
| D9920 |
|
336 |
335 |
$22K |
| D0274 |
Bitewings - four radiographic images |
835 |
824 |
$22K |
| D1120 |
Prophylaxis - child |
492 |
489 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
762 |
756 |
$14K |
| D0330 |
Panoramic radiographic image |
272 |
269 |
$8K |
| D9110 |
|
273 |
266 |
$8K |
| D2332 |
|
109 |
87 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
892 |
881 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
802 |
792 |
$6K |
| D2331 |
|
83 |
61 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
123 |
122 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
51 |
39 |
$3K |
| D0272 |
Bitewings - two radiographic images |
182 |
181 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
28 |
27 |
$2K |