| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,868 |
876 |
$98K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,367 |
695 |
$68K |
| D1110 |
Prophylaxis - adult |
1,247 |
1,214 |
$41K |
| D0210 |
Intraoral - complete series of radiographic images |
571 |
528 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
1,888 |
1,865 |
$32K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
463 |
262 |
$29K |
| D0274 |
Bitewings - four radiographic images |
1,478 |
1,449 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
988 |
940 |
$25K |
| D1120 |
Prophylaxis - child |
1,242 |
1,210 |
$24K |
| D1206 |
Topical application of fluoride varnish |
1,639 |
1,600 |
$24K |
| D2331 |
|
385 |
224 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
862 |
829 |
$18K |
| D0330 |
Panoramic radiographic image |
393 |
376 |
$18K |
| D4341 |
|
180 |
63 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,001 |
1,825 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
261 |
99 |
$15K |
| D1351 |
Sealant - per tooth |
585 |
156 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
2,057 |
2,001 |
$10K |
| D2330 |
|
108 |
67 |
$5K |
| D2332 |
|
73 |
46 |
$5K |
| D0272 |
Bitewings - two radiographic images |
413 |
407 |
$4K |
| D0350 |
|
435 |
122 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
207 |
201 |
$3K |
| D2335 |
|
30 |
17 |
$2K |
| D0180 |
|
20 |
18 |
$500.65 |