| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,006 |
1,729 |
$847K |
| D2394 |
|
1,710 |
1,089 |
$559K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,061 |
773 |
$215K |
| D1206 |
Topical application of fluoride varnish |
5,893 |
5,709 |
$185K |
| D1120 |
Prophylaxis - child |
3,505 |
3,402 |
$181K |
| D1110 |
Prophylaxis - adult |
2,546 |
2,463 |
$174K |
| D0120 |
Periodic oral evaluation - established patient |
4,503 |
4,318 |
$173K |
| D0274 |
Bitewings - four radiographic images |
2,164 |
2,103 |
$108K |
| D1351 |
Sealant - per tooth |
2,373 |
378 |
$106K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,386 |
1,243 |
$83K |
| D0210 |
Intraoral - complete series of radiographic images |
335 |
311 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
149 |
68 |
$21K |
| D0330 |
Panoramic radiographic image |
253 |
251 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
370 |
345 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
562 |
479 |
$12K |
| D0272 |
Bitewings - two radiographic images |
67 |
67 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
50 |
50 |
$242.11 |
| D0603 |
|
5,599 |
5,328 |
$0.00 |
| D0602 |
|
296 |
281 |
$0.00 |
| D0601 |
|
33 |
32 |
$0.00 |