| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,590 |
1,004 |
$175K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,587 |
906 |
$173K |
| D0140 |
Limited oral evaluation - problem focused |
4,074 |
3,755 |
$147K |
| D0330 |
Panoramic radiographic image |
2,045 |
1,868 |
$119K |
| D0120 |
Periodic oral evaluation - established patient |
4,817 |
4,364 |
$117K |
| D1110 |
Prophylaxis - adult |
2,153 |
1,973 |
$113K |
| D1120 |
Prophylaxis - child |
3,005 |
2,707 |
$108K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,123 |
720 |
$99K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,606 |
3,230 |
$71K |
| D0274 |
Bitewings - four radiographic images |
848 |
778 |
$32K |
| D0272 |
Bitewings - two radiographic images |
650 |
589 |
$16K |
| D1351 |
Sealant - per tooth |
401 |
29 |
$8K |
| D2330 |
|
72 |
51 |
$7K |
| D1320 |
|
93 |
86 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
58 |
51 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
28 |
23 |
$355.50 |
| D1999 |
|
53 |
29 |
$0.00 |