| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,072 |
1,254 |
$133K |
| D1120 |
Prophylaxis - child |
2,945 |
2,916 |
$127K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,421 |
1,003 |
$105K |
| D0120 |
Periodic oral evaluation - established patient |
3,933 |
3,903 |
$104K |
| D0210 |
Intraoral - complete series of radiographic images |
1,350 |
1,322 |
$86K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,933 |
2,902 |
$80K |
| D1110 |
Prophylaxis - adult |
2,031 |
2,007 |
$66K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,156 |
1,126 |
$56K |
| D0274 |
Bitewings - four radiographic images |
1,628 |
1,621 |
$50K |
| D0140 |
Limited oral evaluation - problem focused |
1,318 |
1,280 |
$36K |
| D1351 |
Sealant - per tooth |
945 |
228 |
$36K |
| D1206 |
Topical application of fluoride varnish |
1,637 |
1,622 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,090 |
1,058 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
79 |
52 |
$7K |
| D0272 |
Bitewings - two radiographic images |
176 |
175 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
42 |
37 |
$3K |
| D2330 |
|
58 |
29 |
$3K |
| D2335 |
|
20 |
13 |
$2K |
| D2394 |
|
15 |
14 |
$2K |
| D0330 |
Panoramic radiographic image |
14 |
12 |
$943.08 |
| D0230 |
Intraoral - periapical each additional radiographic image |
73 |
53 |
$800.87 |