| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,923 |
1,349 |
$154K |
| D1120 |
Prophylaxis - child |
3,287 |
3,125 |
$137K |
| D1351 |
Sealant - per tooth |
1,797 |
989 |
$136K |
| D0120 |
Periodic oral evaluation - established patient |
4,231 |
4,028 |
$119K |
| D4341 |
|
593 |
301 |
$101K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,199 |
3,044 |
$84K |
| D4342 |
|
543 |
338 |
$60K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,156 |
896 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,002 |
1,918 |
$46K |
| D1110 |
Prophylaxis - adult |
992 |
954 |
$43K |
| D0274 |
Bitewings - four radiographic images |
2,398 |
2,272 |
$42K |
| D0210 |
Intraoral - complete series of radiographic images |
1,136 |
1,099 |
$35K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
206 |
162 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
3,823 |
3,524 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,265 |
3,005 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
405 |
382 |
$7K |
| D2331 |
|
54 |
24 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
117 |
66 |
$6K |
| D4910 |
|
84 |
84 |
$6K |
| D0272 |
Bitewings - two radiographic images |
370 |
341 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
38 |
27 |
$3K |