| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,204 |
2,337 |
$504K |
| D0120 |
Periodic oral evaluation - established patient |
7,501 |
7,112 |
$226K |
| D1110 |
Prophylaxis - adult |
4,698 |
4,507 |
$223K |
| D1120 |
Prophylaxis - child |
4,807 |
4,613 |
$209K |
| D1206 |
Topical application of fluoride varnish |
7,341 |
7,005 |
$188K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,510 |
942 |
$141K |
| D0210 |
Intraoral - complete series of radiographic images |
1,580 |
1,497 |
$122K |
| D8670 |
Periodic orthodontic treatment visit |
590 |
532 |
$81K |
| D0140 |
Limited oral evaluation - problem focused |
1,618 |
1,456 |
$79K |
| D0274 |
Bitewings - four radiographic images |
2,163 |
2,060 |
$69K |
| D0220 |
Intraoral - periapical first radiographic image |
3,678 |
3,390 |
$67K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
436 |
287 |
$54K |
| D0272 |
Bitewings - two radiographic images |
1,655 |
1,581 |
$50K |
| D1351 |
Sealant - per tooth |
1,253 |
193 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
879 |
829 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,137 |
1,903 |
$32K |
| D0330 |
Panoramic radiographic image |
298 |
286 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
165 |
85 |
$18K |
| D8660 |
|
56 |
54 |
$6K |
| D0340 |
|
61 |
55 |
$3K |
| D0470 |
|
44 |
42 |
$3K |
| D0350 |
|
63 |
55 |
$2K |
| D4355 |
|
13 |
13 |
$902.22 |