| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,867 |
1,827 |
$324K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,562 |
1,748 |
$221K |
| D1110 |
Prophylaxis - adult |
4,066 |
4,061 |
$201K |
| D0120 |
Periodic oral evaluation - established patient |
5,398 |
5,396 |
$141K |
| D1351 |
Sealant - per tooth |
3,971 |
953 |
$111K |
| D1120 |
Prophylaxis - child |
2,681 |
2,680 |
$103K |
| D0274 |
Bitewings - four radiographic images |
2,787 |
2,786 |
$90K |
| D1206 |
Topical application of fluoride varnish |
3,736 |
3,734 |
$79K |
| D0220 |
Intraoral - periapical first radiographic image |
4,622 |
4,557 |
$72K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,780 |
1,778 |
$71K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
306 |
218 |
$43K |
| D0210 |
Intraoral - complete series of radiographic images |
648 |
645 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,909 |
3,711 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
803 |
792 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
440 |
222 |
$31K |
| D0272 |
Bitewings - two radiographic images |
499 |
498 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
354 |
354 |
$8K |
| D1999 |
|
383 |
320 |
$0.00 |