| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,452 |
1,532 |
$206K |
| D1120 |
Prophylaxis - child |
4,640 |
4,480 |
$186K |
| D0120 |
Periodic oral evaluation - established patient |
5,195 |
5,022 |
$141K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,173 |
1,379 |
$126K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,100 |
766 |
$90K |
| D1206 |
Topical application of fluoride varnish |
2,833 |
2,770 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,689 |
2,589 |
$58K |
| D0210 |
Intraoral - complete series of radiographic images |
1,560 |
1,498 |
$41K |
| D0274 |
Bitewings - four radiographic images |
2,260 |
2,211 |
$38K |
| D2335 |
|
365 |
206 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
1,740 |
1,675 |
$30K |
| D1351 |
Sealant - per tooth |
358 |
214 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
2,828 |
2,666 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,713 |
1,464 |
$13K |
| D2332 |
|
138 |
99 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
312 |
292 |
$8K |
| D0272 |
Bitewings - two radiographic images |
745 |
691 |
$7K |
| D2331 |
|
106 |
78 |
$7K |
| D0330 |
Panoramic radiographic image |
234 |
234 |
$6K |
| D2330 |
|
111 |
91 |
$6K |
| D4355 |
|
147 |
142 |
$5K |
| D2394 |
|
35 |
25 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
15 |
14 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
15 |
$821.52 |
| D0270 |
|
16 |
14 |
$89.60 |