| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,068 |
643 |
$96K |
| D1110 |
Prophylaxis - adult |
2,436 |
2,384 |
$96K |
| D0330 |
Panoramic radiographic image |
2,055 |
1,460 |
$78K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,040 |
610 |
$77K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,880 |
2,477 |
$71K |
| D1120 |
Prophylaxis - child |
1,999 |
1,977 |
$63K |
| D0274 |
Bitewings - four radiographic images |
2,752 |
2,697 |
$61K |
| D0120 |
Periodic oral evaluation - established patient |
3,207 |
3,160 |
$55K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,891 |
2,857 |
$54K |
| D0140 |
Limited oral evaluation - problem focused |
2,310 |
1,850 |
$43K |
| D0210 |
Intraoral - complete series of radiographic images |
2,418 |
1,266 |
$42K |
| D4341 |
|
920 |
335 |
$41K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
486 |
210 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
2,797 |
2,278 |
$21K |
| D1351 |
Sealant - per tooth |
491 |
150 |
$16K |
| D2740 |
Crown - porcelain/ceramic |
220 |
174 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,527 |
736 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
81 |
37 |
$4K |
| D0272 |
Bitewings - two radiographic images |
149 |
142 |
$3K |
| D4355 |
|
28 |
28 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
13 |
$2K |