| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,690 |
2,513 |
$439K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,587 |
1,625 |
$316K |
| D0120 |
Periodic oral evaluation - established patient |
6,842 |
6,767 |
$178K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,780 |
951 |
$142K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,913 |
1,889 |
$76K |
| D2160 |
|
356 |
251 |
$34K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
228 |
167 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
800 |
785 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
348 |
256 |
$29K |
| D2140 |
|
246 |
179 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
857 |
834 |
$13K |
| D1120 |
Prophylaxis - child |
225 |
225 |
$9K |
| D1206 |
Topical application of fluoride varnish |
291 |
291 |
$7K |
| D2331 |
|
21 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
37 |
37 |
$849.31 |