| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,995 |
3,611 |
$746K |
| D1120 |
Prophylaxis - child |
17,080 |
16,789 |
$744K |
| D0120 |
Periodic oral evaluation - established patient |
17,918 |
17,637 |
$532K |
| D1351 |
Sealant - per tooth |
14,764 |
3,139 |
$504K |
| D1206 |
Topical application of fluoride varnish |
18,919 |
18,626 |
$469K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,507 |
1,693 |
$243K |
| D1110 |
Prophylaxis - adult |
2,926 |
2,885 |
$179K |
| D0330 |
Panoramic radiographic image |
3,351 |
3,286 |
$142K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,859 |
1,817 |
$97K |
| D0272 |
Bitewings - two radiographic images |
6,209 |
6,097 |
$94K |
| D0140 |
Limited oral evaluation - problem focused |
2,087 |
1,974 |
$92K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
467 |
383 |
$72K |
| D0220 |
Intraoral - periapical first radiographic image |
6,521 |
6,405 |
$63K |
| D7140 |
Extraction, erupted tooth or exposed root |
543 |
392 |
$62K |
| D0274 |
Bitewings - four radiographic images |
1,716 |
1,696 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,225 |
6,116 |
$39K |
| D1330 |
|
5,228 |
5,154 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
973 |
946 |
$22K |
| D3120 |
|
61 |
42 |
$2K |
| D2940 |
|
29 |
12 |
$1K |