| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,973 |
1,218 |
$231K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,053 |
1,039 |
$170K |
| D4346 |
|
843 |
512 |
$153K |
| D1351 |
Sealant - per tooth |
4,381 |
1,316 |
$104K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,450 |
5,436 |
$93K |
| D1120 |
Prophylaxis - child |
2,938 |
2,935 |
$92K |
| D0272 |
Bitewings - two radiographic images |
4,091 |
4,078 |
$82K |
| D1110 |
Prophylaxis - adult |
1,748 |
1,736 |
$80K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,316 |
2,311 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
3,311 |
3,299 |
$76K |
| D0210 |
Intraoral - complete series of radiographic images |
1,037 |
1,016 |
$56K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
225 |
126 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
755 |
732 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,301 |
1,270 |
$14K |
| D0330 |
Panoramic radiographic image |
252 |
249 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
82 |
37 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
568 |
564 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
56 |
43 |
$5K |
| D0602 |
|
95 |
94 |
$0.00 |
| D0603 |
|
854 |
848 |
$0.00 |
| D0350 |
|
12 |
12 |
$0.00 |