| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,125 |
1,005 |
$237K |
| D1110 |
Prophylaxis - adult |
2,873 |
2,839 |
$118K |
| D0120 |
Periodic oral evaluation - established patient |
3,179 |
3,163 |
$78K |
| D0274 |
Bitewings - four radiographic images |
2,537 |
2,509 |
$66K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,990 |
1,960 |
$63K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,408 |
495 |
$62K |
| D1120 |
Prophylaxis - child |
1,557 |
1,550 |
$62K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,888 |
1,885 |
$45K |
| D0140 |
Limited oral evaluation - problem focused |
1,565 |
1,516 |
$44K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
393 |
235 |
$34K |
| D0330 |
Panoramic radiographic image |
939 |
924 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
2,738 |
2,573 |
$27K |
| D1351 |
Sealant - per tooth |
779 |
207 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,721 |
1,364 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
71 |
51 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
95 |
37 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
36 |
36 |
$1K |
| D1206 |
Topical application of fluoride varnish |
23 |
23 |
$575.00 |
| D0240 |
|
26 |
13 |
$568.00 |
| D0272 |
Bitewings - two radiographic images |
24 |
24 |
$556.30 |