| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,001 |
1,050 |
$151K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,300 |
1,119 |
$142K |
| D0120 |
Periodic oral evaluation - established patient |
4,866 |
4,793 |
$124K |
| D1110 |
Prophylaxis - adult |
3,184 |
3,123 |
$112K |
| D1120 |
Prophylaxis - child |
2,329 |
2,297 |
$102K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,626 |
2,594 |
$66K |
| D0210 |
Intraoral - complete series of radiographic images |
1,066 |
1,051 |
$59K |
| D0140 |
Limited oral evaluation - problem focused |
1,648 |
1,584 |
$46K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
513 |
320 |
$45K |
| D7140 |
Extraction, erupted tooth or exposed root |
628 |
308 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,231 |
1,220 |
$38K |
| D0330 |
Panoramic radiographic image |
385 |
356 |
$21K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
317 |
166 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
418 |
407 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,311 |
1,241 |
$15K |
| D2160 |
|
81 |
59 |
$6K |
| D2140 |
|
91 |
57 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
66 |
36 |
$682.04 |
| D0272 |
Bitewings - two radiographic images |
14 |
14 |
$424.32 |