| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,838 |
2,356 |
$383K |
| D2752 |
|
522 |
458 |
$380K |
| D1110 |
Prophylaxis - adult |
6,882 |
6,881 |
$377K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,881 |
1,652 |
$255K |
| D0120 |
Periodic oral evaluation - established patient |
6,599 |
6,599 |
$181K |
| D0210 |
Intraoral - complete series of radiographic images |
2,319 |
2,317 |
$100K |
| D0274 |
Bitewings - four radiographic images |
3,618 |
3,618 |
$99K |
| D2954 |
|
429 |
395 |
$84K |
| D1120 |
Prophylaxis - child |
1,910 |
1,910 |
$81K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,432 |
2,432 |
$72K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
704 |
664 |
$65K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,138 |
3,138 |
$44K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
133 |
132 |
$27K |
| D2394 |
|
182 |
173 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,500 |
1,497 |
$20K |
| D3320 |
|
49 |
45 |
$16K |
| D2331 |
|
95 |
89 |
$12K |
| D2332 |
|
66 |
65 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
521 |
521 |
$7K |
| D2335 |
|
26 |
26 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
12 |
12 |
$5K |
| D1206 |
Topical application of fluoride varnish |
25 |
25 |
$690.00 |
| D0272 |
Bitewings - two radiographic images |
28 |
28 |
$476.00 |
| D0140 |
Limited oral evaluation - problem focused |
27 |
27 |
$364.00 |
| D1999 |
|
17 |
17 |
$0.00 |