| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1351 |
Sealant - per tooth |
376 |
335 |
$68K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
251 |
232 |
$27K |
| D0330 |
Panoramic radiographic image |
656 |
641 |
$24K |
| D1110 |
Prophylaxis - adult |
643 |
638 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
822 |
802 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,010 |
989 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
160 |
154 |
$13K |
| D1120 |
Prophylaxis - child |
384 |
383 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
124 |
115 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
337 |
333 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
556 |
538 |
$10K |
| D2740 |
Crown - porcelain/ceramic |
17 |
17 |
$9K |
| D2332 |
|
55 |
55 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
63 |
61 |
$5K |
| D0603 |
|
487 |
472 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
370 |
363 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
369 |
362 |
$3K |
| D1330 |
|
492 |
477 |
$2K |
| D2330 |
|
25 |
24 |
$1K |