| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,020 |
1,043 |
$236K |
| D1110 |
Prophylaxis - adult |
3,048 |
2,850 |
$162K |
| D0330 |
Panoramic radiographic image |
1,737 |
1,644 |
$114K |
| D0274 |
Bitewings - four radiographic images |
3,024 |
2,846 |
$106K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,847 |
3,630 |
$86K |
| D0120 |
Periodic oral evaluation - established patient |
3,081 |
2,915 |
$80K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,683 |
1,616 |
$70K |
| D1120 |
Prophylaxis - child |
1,672 |
1,615 |
$65K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
308 |
203 |
$51K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
465 |
283 |
$44K |
| D0140 |
Limited oral evaluation - problem focused |
864 |
770 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
1,946 |
1,705 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
954 |
424 |
$13K |
| D0272 |
Bitewings - two radiographic images |
213 |
208 |
$6K |
| D1206 |
Topical application of fluoride varnish |
145 |
141 |
$4K |
| D4910 |
|
53 |
53 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
15 |
12 |
$2K |