| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,257 |
4,559 |
$1.08M |
| D1120 |
Prophylaxis - child |
15,876 |
15,859 |
$708K |
| D0120 |
Periodic oral evaluation - established patient |
18,119 |
18,109 |
$656K |
| D1208 |
Topical application of fluoride, excluding varnish |
13,594 |
13,589 |
$392K |
| D1110 |
Prophylaxis - adult |
5,006 |
5,006 |
$288K |
| D1351 |
Sealant - per tooth |
8,315 |
1,776 |
$288K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,682 |
2,194 |
$267K |
| D0272 |
Bitewings - two radiographic images |
6,008 |
6,002 |
$165K |
| D0220 |
Intraoral - periapical first radiographic image |
8,152 |
8,129 |
$159K |
| D1206 |
Topical application of fluoride varnish |
4,576 |
4,574 |
$140K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,136 |
7,441 |
$112K |
| D0274 |
Bitewings - four radiographic images |
2,324 |
2,322 |
$101K |
| D0210 |
Intraoral - complete series of radiographic images |
1,117 |
1,115 |
$97K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,018 |
1,016 |
$65K |
| D0240 |
|
2,543 |
1,270 |
$58K |
| D0330 |
Panoramic radiographic image |
515 |
515 |
$42K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
241 |
217 |
$38K |
| D7140 |
Extraction, erupted tooth or exposed root |
308 |
211 |
$27K |
| D0145 |
Oral evaluation for a patient under three years of age |
559 |
559 |
$24K |
| D0191 |
|
759 |
757 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
103 |
103 |
$6K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
28 |
25 |
$6K |
| D9248 |
|
12 |
12 |
$2K |
| D2330 |
|
17 |
13 |
$1K |
| D2331 |
|
13 |
12 |
$1K |