| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
686 |
486 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
1,031 |
1,025 |
$24K |
| D0350 |
|
1,163 |
1,131 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
647 |
619 |
$23K |
| D1120 |
Prophylaxis - child |
1,023 |
1,004 |
$21K |
| D1206 |
Topical application of fluoride varnish |
1,456 |
1,431 |
$19K |
| D1110 |
Prophylaxis - adult |
597 |
587 |
$16K |
| D0274 |
Bitewings - four radiographic images |
694 |
678 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
266 |
184 |
$13K |
| D1351 |
Sealant - per tooth |
460 |
107 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
97 |
81 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
736 |
540 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
762 |
723 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
285 |
259 |
$6K |
| D0330 |
Panoramic radiographic image |
148 |
147 |
$5K |
| D0272 |
Bitewings - two radiographic images |
336 |
331 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
95 |
49 |
$4K |
| D0240 |
|
138 |
102 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
61 |
59 |
$1K |