| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,028 |
722 |
$164K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
979 |
341 |
$78K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
737 |
323 |
$66K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,295 |
1,084 |
$46K |
| D1110 |
Prophylaxis - adult |
838 |
680 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
1,525 |
1,266 |
$38K |
| D0274 |
Bitewings - four radiographic images |
1,345 |
1,180 |
$31K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,231 |
1,026 |
$27K |
| D1120 |
Prophylaxis - child |
865 |
726 |
$25K |
| D0330 |
Panoramic radiographic image |
596 |
557 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
707 |
553 |
$23K |
| D4341 |
|
182 |
30 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
214 |
164 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,628 |
1,261 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,752 |
420 |
$9K |
| D1351 |
Sealant - per tooth |
60 |
12 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
41 |
13 |
$2K |
| D0272 |
Bitewings - two radiographic images |
67 |
51 |
$1K |