| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,746 |
990 |
$262K |
| D0120 |
Periodic oral evaluation - established patient |
2,951 |
2,873 |
$79K |
| D1351 |
Sealant - per tooth |
2,852 |
522 |
$73K |
| D1110 |
Prophylaxis - adult |
1,095 |
1,079 |
$58K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,189 |
3,254 |
$47K |
| D1120 |
Prophylaxis - child |
1,281 |
1,261 |
$45K |
| D0274 |
Bitewings - four radiographic images |
1,611 |
1,573 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
3,664 |
3,487 |
$37K |
| D0330 |
Panoramic radiographic image |
1,506 |
1,437 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,165 |
2,136 |
$30K |
| D0145 |
Oral evaluation for a patient under three years of age |
171 |
169 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,004 |
987 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
619 |
594 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
176 |
94 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
47 |
13 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
88 |
87 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
25 |
25 |
$555.89 |
| D0270 |
|
13 |
13 |
$76.30 |
| D0603 |
|
3,811 |
3,729 |
$0.00 |
| D0601 |
|
38 |
36 |
$0.00 |