| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,004 |
1,336 |
$206K |
| D0120 |
Periodic oral evaluation - established patient |
4,874 |
4,723 |
$123K |
| D1110 |
Prophylaxis - adult |
3,051 |
2,947 |
$114K |
| D1120 |
Prophylaxis - child |
2,975 |
2,869 |
$80K |
| D1206 |
Topical application of fluoride varnish |
4,808 |
4,639 |
$77K |
| D1351 |
Sealant - per tooth |
2,196 |
580 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,385 |
1,313 |
$59K |
| D0274 |
Bitewings - four radiographic images |
1,769 |
1,696 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
3,493 |
3,291 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,237 |
2,644 |
$50K |
| D0330 |
Panoramic radiographic image |
634 |
614 |
$35K |
| D0272 |
Bitewings - two radiographic images |
1,128 |
1,089 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
512 |
494 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
205 |
158 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
115 |
82 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
115 |
61 |
$7K |
| D4355 |
|
32 |
29 |
$2K |