| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,887 |
2,590 |
$275K |
| D1110 |
Prophylaxis - adult |
7,540 |
7,403 |
$271K |
| D0120 |
Periodic oral evaluation - established patient |
9,597 |
9,303 |
$164K |
| D0274 |
Bitewings - four radiographic images |
6,062 |
5,923 |
$128K |
| D1206 |
Topical application of fluoride varnish |
7,747 |
7,376 |
$118K |
| D1120 |
Prophylaxis - child |
3,720 |
3,477 |
$95K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,842 |
3,703 |
$90K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,427 |
1,096 |
$73K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
714 |
610 |
$54K |
| D7140 |
Extraction, erupted tooth or exposed root |
960 |
471 |
$47K |
| D0330 |
Panoramic radiographic image |
1,557 |
1,542 |
$32K |
| D4910 |
|
513 |
508 |
$30K |
| D0272 |
Bitewings - two radiographic images |
1,882 |
1,755 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
1,093 |
1,062 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
2,874 |
2,706 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
517 |
514 |
$21K |
| D2331 |
|
295 |
227 |
$18K |
| D0603 |
|
2,148 |
2,129 |
$10K |
| D0601 |
|
1,716 |
1,701 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
706 |
403 |
$3K |
| D4341 |
|
62 |
12 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
57 |
56 |
$1K |
| D2330 |
|
13 |
12 |
$746.33 |
| D0602 |
|
56 |
56 |
$276.25 |