| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,979 |
3,856 |
$487K |
| D1110 |
Prophylaxis - adult |
8,753 |
8,573 |
$374K |
| D1351 |
Sealant - per tooth |
13,658 |
2,256 |
$277K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,608 |
7,380 |
$268K |
| D1206 |
Topical application of fluoride varnish |
13,465 |
13,091 |
$244K |
| D0120 |
Periodic oral evaluation - established patient |
9,160 |
9,085 |
$238K |
| D0330 |
Panoramic radiographic image |
6,218 |
6,048 |
$213K |
| D4341 |
|
4,907 |
1,246 |
$182K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,195 |
1,782 |
$169K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,604 |
1,071 |
$160K |
| D0274 |
Bitewings - four radiographic images |
10,799 |
10,561 |
$141K |
| D0140 |
Limited oral evaluation - problem focused |
4,932 |
4,670 |
$128K |
| D1120 |
Prophylaxis - child |
5,381 |
5,305 |
$122K |
| D0220 |
Intraoral - periapical first radiographic image |
11,372 |
10,832 |
$110K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,200 |
587 |
$109K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,878 |
7,995 |
$40K |
| D2394 |
|
434 |
355 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,503 |
2,453 |
$31K |
| D1999 |
|
1,639 |
1,336 |
$19K |
| D2332 |
|
143 |
100 |
$16K |
| D2335 |
|
116 |
69 |
$14K |
| D9110 |
|
232 |
189 |
$13K |
| D4910 |
|
136 |
134 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
57 |
26 |
$3K |
| D0272 |
Bitewings - two radiographic images |
241 |
238 |
$2K |
| D2331 |
|
24 |
16 |
$2K |
| D2330 |
|
31 |
14 |
$2K |
| D0270 |
|
285 |
279 |
$2K |
| D4355 |
|
13 |
13 |
$0.00 |