| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,606 |
1,652 |
$221K |
| D1120 |
Prophylaxis - child |
2,604 |
2,501 |
$106K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,138 |
888 |
$100K |
| D0120 |
Periodic oral evaluation - established patient |
3,308 |
3,196 |
$92K |
| D1351 |
Sealant - per tooth |
834 |
486 |
$83K |
| D1110 |
Prophylaxis - adult |
1,291 |
1,258 |
$58K |
| D2332 |
|
526 |
382 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,986 |
1,902 |
$45K |
| D0274 |
Bitewings - four radiographic images |
2,151 |
2,082 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,411 |
1,333 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
3,942 |
3,719 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,196 |
3,033 |
$20K |
| D2331 |
|
190 |
148 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
745 |
710 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
221 |
187 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
154 |
105 |
$12K |
| D4341 |
|
73 |
45 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
74 |
70 |
$2K |
| D0272 |
Bitewings - two radiographic images |
168 |
165 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
19 |
12 |
$1K |