| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,568 |
780 |
$261K |
| D1110 |
Prophylaxis - adult |
2,703 |
2,662 |
$168K |
| D0120 |
Periodic oral evaluation - established patient |
4,226 |
4,167 |
$126K |
| D1120 |
Prophylaxis - child |
2,179 |
2,149 |
$95K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,017 |
3,958 |
$92K |
| D0274 |
Bitewings - four radiographic images |
3,336 |
3,278 |
$76K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,978 |
3,860 |
$53K |
| D0330 |
Panoramic radiographic image |
1,106 |
1,073 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
4,239 |
4,066 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
694 |
641 |
$32K |
| D1351 |
Sealant - per tooth |
877 |
193 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
531 |
522 |
$29K |
| D3120 |
|
662 |
393 |
$23K |
| D1330 |
|
2,269 |
2,236 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
55 |
27 |
$7K |
| D2332 |
|
50 |
29 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
41 |
29 |
$6K |
| D0272 |
Bitewings - two radiographic images |
344 |
340 |
$5K |
| D1206 |
Topical application of fluoride varnish |
148 |
148 |
$4K |