| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2394 |
|
8,204 |
1,841 |
$1.23M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,201 |
882 |
$201K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,399 |
665 |
$153K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,774 |
646 |
$121K |
| D0120 |
Periodic oral evaluation - established patient |
3,371 |
3,222 |
$80K |
| D2335 |
|
670 |
255 |
$76K |
| D0220 |
Intraoral - periapical first radiographic image |
5,012 |
4,468 |
$71K |
| D0330 |
Panoramic radiographic image |
1,344 |
1,282 |
$64K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,641 |
1,543 |
$64K |
| D1110 |
Prophylaxis - adult |
1,723 |
1,664 |
$59K |
| D1120 |
Prophylaxis - child |
2,349 |
2,231 |
$58K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,751 |
3,826 |
$55K |
| D0274 |
Bitewings - four radiographic images |
1,979 |
1,889 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,305 |
3,171 |
$52K |
| D0140 |
Limited oral evaluation - problem focused |
1,429 |
1,224 |
$48K |
| D4355 |
|
546 |
524 |
$33K |
| D0272 |
Bitewings - two radiographic images |
927 |
891 |
$15K |
| D2940 |
|
337 |
204 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
114 |
62 |
$6K |
| D1351 |
Sealant - per tooth |
203 |
65 |
$5K |
| D4341 |
|
41 |
13 |
$3K |