| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,944 |
2,431 |
$367K |
| D0120 |
Periodic oral evaluation - established patient |
6,212 |
5,779 |
$157K |
| D1120 |
Prophylaxis - child |
3,469 |
3,334 |
$148K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,528 |
1,241 |
$147K |
| D0274 |
Bitewings - four radiographic images |
3,847 |
3,556 |
$119K |
| D1110 |
Prophylaxis - adult |
3,145 |
2,839 |
$98K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,246 |
3,116 |
$87K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,937 |
4,421 |
$77K |
| D0140 |
Limited oral evaluation - problem focused |
2,018 |
1,740 |
$53K |
| D0330 |
Panoramic radiographic image |
1,177 |
938 |
$50K |
| D0220 |
Intraoral - periapical first radiographic image |
4,107 |
3,600 |
$48K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
624 |
222 |
$35K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
382 |
240 |
$31K |
| D2332 |
|
328 |
88 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
441 |
388 |
$16K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
251 |
163 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
271 |
255 |
$7K |
| D0272 |
Bitewings - two radiographic images |
144 |
141 |
$4K |
| D2160 |
|
31 |
24 |
$2K |
| D2140 |
|
41 |
29 |
$2K |