| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,361 |
1,469 |
$368K |
| D1120 |
Prophylaxis - child |
7,999 |
7,876 |
$348K |
| D0120 |
Periodic oral evaluation - established patient |
10,832 |
10,679 |
$321K |
| D1351 |
Sealant - per tooth |
8,146 |
1,638 |
$278K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,595 |
11,428 |
$266K |
| D0140 |
Limited oral evaluation - problem focused |
5,450 |
4,329 |
$239K |
| D1110 |
Prophylaxis - adult |
3,563 |
3,520 |
$216K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,247 |
763 |
$132K |
| D3120 |
|
3,326 |
1,978 |
$115K |
| D0330 |
Panoramic radiographic image |
1,961 |
1,929 |
$84K |
| D0274 |
Bitewings - four radiographic images |
3,329 |
3,277 |
$76K |
| D0460 |
|
5,104 |
4,359 |
$50K |
| D4355 |
|
453 |
447 |
$45K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
310 |
180 |
$39K |
| D1330 |
|
6,295 |
6,212 |
$39K |
| D0272 |
Bitewings - two radiographic images |
1,781 |
1,756 |
$28K |
| D9951 |
|
625 |
613 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
383 |
377 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,269 |
1,209 |
$12K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
54 |
41 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
64 |
28 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
370 |
355 |
$5K |
| D1510 |
|
41 |
14 |
$3K |
| D0240 |
|
140 |
138 |
$2K |