| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,097 |
1,188 |
$191K |
| D1110 |
Prophylaxis - adult |
3,484 |
3,220 |
$120K |
| D0140 |
Limited oral evaluation - problem focused |
2,889 |
2,574 |
$94K |
| D0120 |
Periodic oral evaluation - established patient |
3,479 |
3,236 |
$80K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,059 |
582 |
$70K |
| D0210 |
Intraoral - complete series of radiographic images |
1,033 |
960 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
4,093 |
3,715 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,702 |
1,563 |
$51K |
| D0274 |
Bitewings - four radiographic images |
1,488 |
1,371 |
$42K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
342 |
191 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,770 |
2,043 |
$31K |
| D4355 |
|
461 |
435 |
$30K |
| D0330 |
Panoramic radiographic image |
403 |
346 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
288 |
137 |
$17K |
| D1206 |
Topical application of fluoride varnish |
238 |
229 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
295 |
244 |
$4K |
| D2332 |
|
44 |
26 |
$4K |
| D2331 |
|
39 |
24 |
$3K |
| D9110 |
|
26 |
26 |
$1K |
| D0160 |
|
13 |
12 |
$884.40 |