| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,386 |
1,334 |
$164K |
| D1110 |
Prophylaxis - adult |
3,503 |
3,491 |
$132K |
| D1351 |
Sealant - per tooth |
4,971 |
993 |
$126K |
| D0120 |
Periodic oral evaluation - established patient |
4,458 |
4,446 |
$112K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,632 |
940 |
$88K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,182 |
760 |
$79K |
| D0330 |
Panoramic radiographic image |
1,630 |
1,628 |
$65K |
| D0272 |
Bitewings - two radiographic images |
3,784 |
3,774 |
$62K |
| D1120 |
Prophylaxis - child |
1,791 |
1,788 |
$56K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,741 |
2,736 |
$51K |
| D2332 |
|
612 |
360 |
$43K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
436 |
327 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
899 |
895 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
3,024 |
3,014 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,989 |
2,980 |
$24K |
| D2330 |
|
299 |
164 |
$16K |
| D0603 |
|
1,401 |
1,401 |
$14K |
| D1330 |
|
1,420 |
1,420 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
87 |
55 |
$5K |
| D2394 |
|
45 |
39 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
23 |
23 |
$1K |
| D4346 |
|
26 |
26 |
$956.90 |