| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,166 |
1,573 |
$158K |
| D1120 |
Prophylaxis - child |
3,337 |
3,226 |
$136K |
| D0120 |
Periodic oral evaluation - established patient |
3,107 |
2,991 |
$86K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,498 |
2,409 |
$65K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,397 |
1,106 |
$59K |
| D1351 |
Sealant - per tooth |
912 |
484 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,812 |
1,742 |
$41K |
| D0274 |
Bitewings - four radiographic images |
2,016 |
1,936 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
4,156 |
3,919 |
$25K |
| D1206 |
Topical application of fluoride varnish |
762 |
745 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,455 |
3,242 |
$17K |
| D4341 |
|
88 |
36 |
$15K |
| D1110 |
Prophylaxis - adult |
146 |
140 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
256 |
251 |
$4K |
| D0272 |
Bitewings - two radiographic images |
364 |
357 |
$3K |
| D2331 |
|
16 |
13 |
$1K |
| D0330 |
Panoramic radiographic image |
48 |
38 |
$836.20 |
| D7140 |
Extraction, erupted tooth or exposed root |
14 |
13 |
$821.52 |
| D0210 |
Intraoral - complete series of radiographic images |
48 |
47 |
$367.10 |
| D9310 |
|
13 |
13 |
$205.20 |