| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,217 |
522 |
$86K |
| D0330 |
Panoramic radiographic image |
934 |
928 |
$79K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
689 |
408 |
$63K |
| D1110 |
Prophylaxis - adult |
896 |
895 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
970 |
967 |
$43K |
| D1206 |
Topical application of fluoride varnish |
1,350 |
1,346 |
$41K |
| D7140 |
Extraction, erupted tooth or exposed root |
391 |
181 |
$39K |
| D1330 |
|
1,138 |
1,138 |
$38K |
| D1351 |
Sealant - per tooth |
963 |
196 |
$37K |
| D0274 |
Bitewings - four radiographic images |
908 |
907 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
1,610 |
1,568 |
$27K |
| D0180 |
|
293 |
293 |
$27K |
| D1120 |
Prophylaxis - child |
521 |
521 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,443 |
1,279 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
463 |
451 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
351 |
351 |
$13K |
| D0272 |
Bitewings - two radiographic images |
125 |
125 |
$5K |