| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,859 |
3,320 |
$604K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,648 |
2,989 |
$550K |
| D1120 |
Prophylaxis - child |
9,540 |
9,044 |
$260K |
| D0120 |
Periodic oral evaluation - established patient |
13,632 |
12,975 |
$253K |
| D1110 |
Prophylaxis - adult |
6,155 |
5,844 |
$220K |
| D1999 |
|
11,194 |
10,296 |
$211K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,754 |
13,943 |
$205K |
| D1206 |
Topical application of fluoride varnish |
8,501 |
8,059 |
$175K |
| D0330 |
Panoramic radiographic image |
3,674 |
3,437 |
$164K |
| D0240 |
|
8,196 |
3,840 |
$138K |
| D0272 |
Bitewings - two radiographic images |
5,804 |
5,531 |
$100K |
| D0274 |
Bitewings - four radiographic images |
4,095 |
3,894 |
$95K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,550 |
2,365 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
3,712 |
3,371 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,265 |
2,972 |
$31K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
370 |
245 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
358 |
243 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
753 |
686 |
$20K |
| D1351 |
Sealant - per tooth |
425 |
122 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
27 |
27 |
$2K |
| D2394 |
|
13 |
12 |
$1K |