| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,970 |
1,390 |
$195K |
| D0274 |
Bitewings - four radiographic images |
4,348 |
4,068 |
$108K |
| D1110 |
Prophylaxis - adult |
2,373 |
2,215 |
$81K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,982 |
2,808 |
$75K |
| D0330 |
Panoramic radiographic image |
2,323 |
2,186 |
$67K |
| D1351 |
Sealant - per tooth |
2,289 |
286 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
2,725 |
2,528 |
$50K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
634 |
322 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
1,169 |
1,060 |
$30K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
373 |
229 |
$25K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
249 |
111 |
$22K |
| D1120 |
Prophylaxis - child |
835 |
789 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,732 |
1,614 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
247 |
234 |
$12K |
| D1206 |
Topical application of fluoride varnish |
219 |
206 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
169 |
160 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
233 |
136 |
$2K |