| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,987 |
1,388 |
$212K |
| D1110 |
Prophylaxis - adult |
4,683 |
4,615 |
$180K |
| D0120 |
Periodic oral evaluation - established patient |
6,400 |
6,295 |
$165K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,992 |
5,870 |
$126K |
| D0274 |
Bitewings - four radiographic images |
3,561 |
3,507 |
$114K |
| D0140 |
Limited oral evaluation - problem focused |
3,108 |
2,936 |
$109K |
| D0220 |
Intraoral - periapical first radiographic image |
6,805 |
6,655 |
$103K |
| D0330 |
Panoramic radiographic image |
1,786 |
1,758 |
$103K |
| D1120 |
Prophylaxis - child |
3,636 |
3,572 |
$100K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,262 |
2,229 |
$98K |
| D1206 |
Topical application of fluoride varnish |
5,184 |
5,107 |
$86K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
810 |
571 |
$65K |
| D4355 |
|
418 |
411 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,484 |
1,459 |
$27K |
| D1351 |
Sealant - per tooth |
991 |
226 |
$26K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
138 |
110 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
910 |
900 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
89 |
36 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
131 |
57 |
$8K |
| D2940 |
|
35 |
25 |
$1K |