| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,227 |
605 |
$280K |
| D0274 |
Bitewings - four radiographic images |
2,899 |
2,770 |
$145K |
| D0120 |
Periodic oral evaluation - established patient |
3,520 |
3,362 |
$140K |
| D1110 |
Prophylaxis - adult |
2,055 |
1,939 |
$139K |
| D1206 |
Topical application of fluoride varnish |
3,983 |
3,834 |
$126K |
| D1120 |
Prophylaxis - child |
2,180 |
2,124 |
$116K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
378 |
222 |
$109K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
319 |
183 |
$58K |
| D0330 |
Panoramic radiographic image |
681 |
644 |
$56K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
287 |
108 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
820 |
737 |
$52K |
| D1351 |
Sealant - per tooth |
525 |
100 |
$23K |
| D9920 |
|
163 |
139 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
222 |
177 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
771 |
669 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
229 |
186 |
$12K |
| D0272 |
Bitewings - two radiographic images |
262 |
257 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
369 |
318 |
$6K |
| D7111 |
|
27 |
13 |
$3K |
| D0602 |
|
1,659 |
1,592 |
$0.00 |
| D0601 |
|
1,131 |
1,098 |
$0.00 |
| D0603 |
|
944 |
914 |
$0.00 |