| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,175 |
802 |
$111K |
| D0120 |
Periodic oral evaluation - established patient |
3,725 |
3,188 |
$84K |
| D1110 |
Prophylaxis - adult |
1,881 |
1,646 |
$79K |
| D1120 |
Prophylaxis - child |
2,258 |
1,898 |
$75K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,763 |
3,204 |
$70K |
| D0330 |
Panoramic radiographic image |
1,190 |
1,014 |
$57K |
| D0272 |
Bitewings - two radiographic images |
1,513 |
1,305 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
375 |
247 |
$27K |
| D1351 |
Sealant - per tooth |
663 |
100 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
324 |
294 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
479 |
355 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
212 |
177 |
$6K |
| D0274 |
Bitewings - four radiographic images |
74 |
63 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
13 |
12 |
$520.00 |
| D1999 |
|
345 |
261 |
$0.00 |