| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,155 |
1,338 |
$415K |
| D1110 |
Prophylaxis - adult |
2,863 |
2,836 |
$185K |
| D0120 |
Periodic oral evaluation - established patient |
5,138 |
5,082 |
$155K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,325 |
589 |
$136K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
677 |
386 |
$114K |
| D1120 |
Prophylaxis - child |
2,463 |
2,432 |
$106K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,242 |
3,203 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
940 |
920 |
$52K |
| D1206 |
Topical application of fluoride varnish |
1,924 |
1,917 |
$49K |
| D0274 |
Bitewings - four radiographic images |
1,672 |
1,653 |
$39K |
| D7140 |
Extraction, erupted tooth or exposed root |
135 |
72 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,310 |
1,293 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
824 |
812 |
$11K |
| D1351 |
Sealant - per tooth |
279 |
51 |
$9K |
| D2740 |
Crown - porcelain/ceramic |
21 |
13 |
$8K |
| D4341 |
|
92 |
39 |
$8K |
| D1330 |
|
1,245 |
1,232 |
$8K |
| D0272 |
Bitewings - two radiographic images |
367 |
360 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
111 |
107 |
$5K |
| D2332 |
|
28 |
14 |
$4K |
| D0330 |
Panoramic radiographic image |
46 |
42 |
$2K |
| D3120 |
|
45 |
31 |
$2K |
| D2950 |
|
17 |
12 |
$1K |