| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,534 |
1,551 |
$643K |
| D1110 |
Prophylaxis - adult |
5,505 |
5,387 |
$401K |
| D0120 |
Periodic oral evaluation - established patient |
9,199 |
8,944 |
$377K |
| D1206 |
Topical application of fluoride varnish |
10,119 |
9,881 |
$330K |
| D1120 |
Prophylaxis - child |
4,960 |
4,839 |
$265K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,361 |
971 |
$264K |
| D1351 |
Sealant - per tooth |
5,488 |
1,347 |
$252K |
| D0274 |
Bitewings - four radiographic images |
4,026 |
3,932 |
$209K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
658 |
419 |
$206K |
| D0330 |
Panoramic radiographic image |
1,239 |
1,182 |
$106K |
| D0272 |
Bitewings - two radiographic images |
2,486 |
2,418 |
$90K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,097 |
1,000 |
$68K |
| D0220 |
Intraoral - periapical first radiographic image |
1,033 |
995 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
854 |
799 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
54 |
24 |
$8K |
| D0603 |
|
4,720 |
4,598 |
$0.00 |
| D0602 |
|
4,847 |
4,750 |
$0.00 |
| D0601 |
|
225 |
221 |
$0.00 |