| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,140 |
1,293 |
$410K |
| D1110 |
Prophylaxis - adult |
4,440 |
4,030 |
$257K |
| D0120 |
Periodic oral evaluation - established patient |
5,838 |
5,400 |
$209K |
| D1206 |
Topical application of fluoride varnish |
6,779 |
6,289 |
$201K |
| D1120 |
Prophylaxis - child |
3,542 |
3,345 |
$182K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
615 |
402 |
$150K |
| D0274 |
Bitewings - four radiographic images |
2,292 |
2,104 |
$103K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
471 |
313 |
$71K |
| D0330 |
Panoramic radiographic image |
809 |
740 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
944 |
827 |
$43K |
| D0210 |
Intraoral - complete series of radiographic images |
702 |
587 |
$39K |
| D0272 |
Bitewings - two radiographic images |
832 |
781 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
45 |
26 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
137 |
127 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
28 |
25 |
$2K |
| D1999 |
|
445 |
379 |
$0.00 |
| D9986 |
|
392 |
380 |
$0.00 |
| D0602 |
|
1,178 |
1,114 |
$0.00 |
| D0603 |
|
4,374 |
4,128 |
$0.00 |
| D1330 |
|
48 |
44 |
$0.00 |