| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,938 |
1,036 |
$108K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,693 |
868 |
$70K |
| D1110 |
Prophylaxis - adult |
1,461 |
1,404 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,832 |
1,723 |
$56K |
| D0330 |
Panoramic radiographic image |
1,550 |
1,457 |
$41K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
414 |
310 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
938 |
921 |
$25K |
| D2331 |
|
450 |
234 |
$24K |
| D0274 |
Bitewings - four radiographic images |
2,030 |
1,933 |
$23K |
| D1206 |
Topical application of fluoride varnish |
1,618 |
1,560 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
2,860 |
2,678 |
$22K |
| D1999 |
|
1,473 |
1,185 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
640 |
606 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
122 |
62 |
$10K |
| D4341 |
|
345 |
131 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,343 |
2,161 |
$4K |
| D2330 |
|
108 |
65 |
$3K |
| D1120 |
Prophylaxis - child |
112 |
110 |
$2K |