| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
662 |
404 |
$91K |
| D1110 |
Prophylaxis - adult |
1,388 |
1,280 |
$82K |
| D0120 |
Periodic oral evaluation - established patient |
1,526 |
1,389 |
$48K |
| D1206 |
Topical application of fluoride varnish |
1,331 |
1,182 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
636 |
573 |
$30K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
138 |
107 |
$26K |
| D0274 |
Bitewings - four radiographic images |
689 |
617 |
$26K |
| D1120 |
Prophylaxis - child |
537 |
481 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
230 |
77 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
212 |
190 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
142 |
88 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
640 |
586 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
16 |
15 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
87 |
51 |
$1K |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$780.00 |
| D9986 |
|
93 |
91 |
$0.00 |