| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,829 |
1,417 |
$288K |
| D4346 |
|
1,519 |
1,467 |
$184K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,348 |
943 |
$132K |
| D0272 |
Bitewings - two radiographic images |
3,631 |
3,556 |
$73K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,018 |
3,933 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,906 |
1,887 |
$64K |
| D1120 |
Prophylaxis - child |
1,933 |
1,898 |
$61K |
| D0120 |
Periodic oral evaluation - established patient |
2,183 |
2,113 |
$51K |
| D0330 |
Panoramic radiographic image |
959 |
947 |
$36K |
| D1351 |
Sealant - per tooth |
1,723 |
518 |
$34K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
360 |
249 |
$32K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
250 |
147 |
$27K |
| D1110 |
Prophylaxis - adult |
536 |
498 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
289 |
281 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
317 |
308 |
$3K |
| D0274 |
Bitewings - four radiographic images |
38 |
38 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
12 |
12 |
$825.48 |
| D0350 |
|
24 |
22 |
$404.36 |
| D0230 |
Intraoral - periapical each additional radiographic image |
23 |
23 |
$219.52 |
| D0603 |
|
896 |
849 |
$0.00 |
| D0602 |
|
12 |
12 |
$0.00 |