| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,261 |
770 |
$65K |
| D1110 |
Prophylaxis - adult |
1,677 |
1,654 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
2,046 |
2,022 |
$34K |
| D0210 |
Intraoral - complete series of radiographic images |
461 |
461 |
$28K |
| D0274 |
Bitewings - four radiographic images |
2,111 |
2,054 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
442 |
165 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
889 |
849 |
$22K |
| D0330 |
Panoramic radiographic image |
974 |
949 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
796 |
794 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
189 |
128 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
215 |
154 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
2,637 |
2,488 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,477 |
1,751 |
$7K |
| D1120 |
Prophylaxis - child |
237 |
237 |
$5K |
| D0272 |
Bitewings - two radiographic images |
233 |
231 |
$2K |
| D1999 |
|
76 |
67 |
$0.00 |