| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,157 |
1,552 |
$379K |
| D1120 |
Prophylaxis - child |
8,302 |
8,211 |
$352K |
| D1351 |
Sealant - per tooth |
10,331 |
2,881 |
$343K |
| D0120 |
Periodic oral evaluation - established patient |
10,964 |
10,842 |
$319K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,904 |
11,779 |
$274K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,217 |
1,271 |
$206K |
| D1110 |
Prophylaxis - adult |
3,482 |
3,445 |
$202K |
| D0272 |
Bitewings - two radiographic images |
7,784 |
7,703 |
$117K |
| D0330 |
Panoramic radiographic image |
2,439 |
2,425 |
$102K |
| D7140 |
Extraction, erupted tooth or exposed root |
932 |
569 |
$96K |
| D0140 |
Limited oral evaluation - problem focused |
1,636 |
1,574 |
$71K |
| D0274 |
Bitewings - four radiographic images |
2,759 |
2,730 |
$61K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
866 |
858 |
$45K |
| D1330 |
|
6,088 |
6,030 |
$37K |
| D3120 |
|
481 |
327 |
$17K |
| D7240 |
Removal of impacted tooth - completely bony |
51 |
14 |
$14K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
86 |
64 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,023 |
980 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
53 |
38 |
$8K |
| D3240 |
|
14 |
13 |
$2K |
| D0240 |
|
109 |
109 |
$1K |
| D9310 |
|
13 |
13 |
$624.00 |