| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,481 |
351 |
$171K |
| D2332 |
|
812 |
282 |
$86K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,338 |
339 |
$83K |
| D7971 |
|
88 |
87 |
$43K |
| D1120 |
Prophylaxis - child |
608 |
600 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,579 |
1,045 |
$23K |
| D0274 |
Bitewings - four radiographic images |
746 |
738 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
640 |
634 |
$17K |
| D1110 |
Prophylaxis - adult |
516 |
506 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
228 |
146 |
$15K |
| D0330 |
Panoramic radiographic image |
567 |
549 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,031 |
1,018 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
382 |
380 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
464 |
456 |
$12K |
| D1351 |
Sealant - per tooth |
354 |
90 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
243 |
241 |
$12K |
| D2335 |
|
61 |
34 |
$8K |
| D2160 |
|
101 |
45 |
$7K |
| D1206 |
Topical application of fluoride varnish |
451 |
445 |
$7K |
| D9310 |
|
292 |
277 |
$6K |
| D0272 |
Bitewings - two radiographic images |
114 |
114 |
$3K |
| D7450 |
|
28 |
24 |
$1K |