| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,903 |
1,552 |
$202K |
| D0120 |
Periodic oral evaluation - established patient |
4,375 |
3,870 |
$94K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,000 |
4,411 |
$94K |
| D0274 |
Bitewings - four radiographic images |
3,370 |
2,963 |
$92K |
| D1110 |
Prophylaxis - adult |
3,049 |
2,641 |
$90K |
| D1120 |
Prophylaxis - child |
2,291 |
2,074 |
$89K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,052 |
637 |
$88K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,088 |
610 |
$61K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,043 |
3,019 |
$59K |
| D0220 |
Intraoral - periapical first radiographic image |
5,482 |
4,603 |
$59K |
| D0140 |
Limited oral evaluation - problem focused |
2,242 |
1,911 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,123 |
981 |
$41K |
| D0210 |
Intraoral - complete series of radiographic images |
866 |
730 |
$39K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
682 |
197 |
$30K |
| D2394 |
|
195 |
127 |
$26K |
| D2330 |
|
272 |
129 |
$13K |
| D1351 |
Sealant - per tooth |
380 |
89 |
$13K |
| D2332 |
|
67 |
41 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
55 |
29 |
$4K |
| D2331 |
|
40 |
25 |
$3K |
| D0272 |
Bitewings - two radiographic images |
60 |
54 |
$2K |
| D1206 |
Topical application of fluoride varnish |
46 |
46 |
$872.90 |
| D2950 |
|
30 |
16 |
$322.40 |
| D0191 |
|
59 |
30 |
$0.00 |