| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,995 |
660 |
$131K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,001 |
1,985 |
$122K |
| D0120 |
Periodic oral evaluation - established patient |
1,686 |
1,675 |
$82K |
| D0210 |
Intraoral - complete series of radiographic images |
1,407 |
1,397 |
$65K |
| D1110 |
Prophylaxis - adult |
661 |
660 |
$54K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,216 |
2,600 |
$49K |
| D1120 |
Prophylaxis - child |
1,332 |
1,329 |
$46K |
| D0274 |
Bitewings - four radiographic images |
1,270 |
1,265 |
$27K |
| D1351 |
Sealant - per tooth |
677 |
149 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,787 |
1,783 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
174 |
92 |
$14K |
| D1206 |
Topical application of fluoride varnish |
478 |
477 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
91 |
54 |
$5K |
| D0350 |
|
2,287 |
749 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
23 |
12 |
$3K |
| D0330 |
Panoramic radiographic image |
420 |
419 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
207 |
206 |
$2K |
| D9430 |
|
52 |
48 |
$2K |
| D0272 |
Bitewings - two radiographic images |
71 |
71 |
$786.00 |
| D0140 |
Limited oral evaluation - problem focused |
106 |
106 |
$0.00 |