| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,135 |
1,545 |
$132K |
| D0120 |
Periodic oral evaluation - established patient |
4,077 |
4,001 |
$102K |
| D1120 |
Prophylaxis - child |
3,709 |
3,637 |
$72K |
| D0274 |
Bitewings - four radiographic images |
3,307 |
3,250 |
$68K |
| D1206 |
Topical application of fluoride varnish |
5,062 |
4,967 |
$64K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,232 |
982 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,106 |
1,096 |
$41K |
| D1110 |
Prophylaxis - adult |
1,437 |
1,413 |
$38K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
345 |
292 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,664 |
1,410 |
$25K |
| D0330 |
Panoramic radiographic image |
1,070 |
1,070 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
2,500 |
2,450 |
$21K |
| D1351 |
Sealant - per tooth |
1,123 |
459 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
758 |
723 |
$15K |
| D0272 |
Bitewings - two radiographic images |
1,006 |
981 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
564 |
543 |
$12K |
| D0145 |
Oral evaluation for a patient under three years of age |
286 |
282 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
77 |
64 |
$4K |
| D2331 |
|
57 |
44 |
$3K |
| D3120 |
|
12 |
12 |
$336.00 |