| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,829 |
2,436 |
$398K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,999 |
1,202 |
$230K |
| D1110 |
Prophylaxis - adult |
3,555 |
3,524 |
$140K |
| D0120 |
Periodic oral evaluation - established patient |
4,817 |
4,783 |
$84K |
| D9630 |
|
3,690 |
3,651 |
$64K |
| D0274 |
Bitewings - four radiographic images |
2,562 |
2,542 |
$59K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,222 |
3,189 |
$58K |
| D1120 |
Prophylaxis - child |
1,866 |
1,854 |
$58K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
566 |
324 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
3,191 |
2,940 |
$28K |
| D1206 |
Topical application of fluoride varnish |
1,282 |
1,282 |
$26K |
| D3120 |
|
1,217 |
651 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,258 |
1,795 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
480 |
454 |
$12K |
| D0330 |
Panoramic radiographic image |
138 |
138 |
$7K |
| D0272 |
Bitewings - two radiographic images |
251 |
251 |
$5K |
| D2394 |
|
37 |
30 |
$5K |
| D9920 |
|
42 |
41 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
82 |
74 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
23 |
12 |
$2K |
| D9994 |
|
568 |
567 |
$0.00 |