| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,309 |
879 |
$141K |
| D1110 |
Prophylaxis - adult |
3,560 |
3,435 |
$134K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
958 |
631 |
$126K |
| D2394 |
|
693 |
423 |
$111K |
| D0120 |
Periodic oral evaluation - established patient |
3,791 |
3,670 |
$98K |
| D0330 |
Panoramic radiographic image |
1,289 |
1,231 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,677 |
1,589 |
$72K |
| D0140 |
Limited oral evaluation - problem focused |
1,795 |
1,674 |
$64K |
| D0210 |
Intraoral - complete series of radiographic images |
864 |
812 |
$61K |
| D1206 |
Topical application of fluoride varnish |
3,205 |
3,100 |
$53K |
| D1120 |
Prophylaxis - child |
1,807 |
1,745 |
$50K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
568 |
368 |
$46K |
| D2335 |
|
311 |
168 |
$38K |
| D0274 |
Bitewings - four radiographic images |
1,050 |
1,011 |
$33K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
293 |
82 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
1,805 |
1,624 |
$27K |
| D4355 |
|
284 |
272 |
$19K |
| D0272 |
Bitewings - two radiographic images |
763 |
742 |
$14K |
| D2332 |
|
151 |
97 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
514 |
269 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
123 |
122 |
$2K |
| D9110 |
|
40 |
39 |
$2K |
| D2331 |
|
18 |
12 |
$2K |