| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,390 |
1,280 |
$548K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,930 |
1,134 |
$383K |
| D1110 |
Prophylaxis - adult |
2,869 |
2,803 |
$180K |
| D0120 |
Periodic oral evaluation - established patient |
3,769 |
3,711 |
$115K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,831 |
4,733 |
$111K |
| D1120 |
Prophylaxis - child |
2,018 |
1,982 |
$90K |
| D0330 |
Panoramic radiographic image |
1,694 |
1,635 |
$74K |
| D0140 |
Limited oral evaluation - problem focused |
1,323 |
1,251 |
$61K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,015 |
973 |
$55K |
| D2750 |
|
112 |
84 |
$54K |
| D0274 |
Bitewings - four radiographic images |
1,779 |
1,730 |
$41K |
| D2332 |
|
227 |
78 |
$30K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
155 |
117 |
$27K |
| D1351 |
Sealant - per tooth |
738 |
163 |
$24K |
| D1330 |
|
2,214 |
2,176 |
$14K |
| D2330 |
|
116 |
54 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
107 |
58 |
$11K |
| D4341 |
|
117 |
41 |
$10K |
| D2950 |
|
106 |
86 |
$8K |
| D0272 |
Bitewings - two radiographic images |
501 |
494 |
$8K |
| D2335 |
|
19 |
12 |
$3K |
| D3120 |
|
78 |
52 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
59 |
59 |
$697.38 |