| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,776 |
891 |
$83K |
| D1120 |
Prophylaxis - child |
2,041 |
1,977 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
2,087 |
2,017 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,161 |
1,113 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
546 |
238 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
226 |
222 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
25 |
16 |
$2K |
| D0274 |
Bitewings - four radiographic images |
598 |
589 |
$1K |
| D0272 |
Bitewings - two radiographic images |
881 |
865 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
528 |
502 |
$1K |
| D1110 |
Prophylaxis - adult |
380 |
374 |
$911.54 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
23 |
12 |
$0.00 |
| D0330 |
Panoramic radiographic image |
333 |
330 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
1,039 |
1,020 |
$0.00 |
| D0240 |
|
169 |
169 |
$0.00 |
| D9248 |
|
119 |
119 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
92 |
89 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
24 |
24 |
$0.00 |