| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,887 |
1,886 |
$70K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
795 |
441 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,724 |
1,723 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
1,571 |
1,570 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
733 |
428 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
2,548 |
2,538 |
$24K |
| D1351 |
Sealant - per tooth |
722 |
183 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,017 |
1,017 |
$22K |
| D1120 |
Prophylaxis - child |
629 |
629 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,386 |
2,383 |
$20K |
| D9310 |
|
269 |
269 |
$13K |
| D0340 |
|
284 |
283 |
$11K |
| D1206 |
Topical application of fluoride varnish |
354 |
354 |
$9K |
| D0470 |
|
326 |
325 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
530 |
530 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
113 |
97 |
$6K |
| D0272 |
Bitewings - two radiographic images |
401 |
401 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
391 |
391 |
$4K |
| D0350 |
|
326 |
325 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
89 |
44 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
167 |
164 |
$2K |
| D0330 |
Panoramic radiographic image |
41 |
41 |
$1K |