| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,061 |
1,378 |
$267K |
| D1351 |
Sealant - per tooth |
8,872 |
1,485 |
$219K |
| D1120 |
Prophylaxis - child |
6,681 |
5,766 |
$171K |
| D0210 |
Intraoral - complete series of radiographic images |
2,551 |
2,134 |
$141K |
| D1206 |
Topical application of fluoride varnish |
6,344 |
5,472 |
$131K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,746 |
2,982 |
$106K |
| D0120 |
Periodic oral evaluation - established patient |
3,019 |
2,836 |
$81K |
| D0350 |
|
2,901 |
2,726 |
$79K |
| D7140 |
Extraction, erupted tooth or exposed root |
780 |
414 |
$57K |
| D0140 |
Limited oral evaluation - problem focused |
1,630 |
1,362 |
$55K |
| D0274 |
Bitewings - four radiographic images |
2,148 |
1,860 |
$53K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
520 |
250 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
1,455 |
1,282 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
71 |
51 |
$10K |
| D0330 |
Panoramic radiographic image |
403 |
276 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
933 |
500 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
117 |
99 |
$2K |
| D1330 |
|
902 |
808 |
$0.00 |
| D1999 |
|
62 |
57 |
$0.00 |