| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,207 |
2,342 |
$260K |
| D1110 |
Prophylaxis - adult |
5,221 |
5,177 |
$239K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,239 |
5,196 |
$183K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,399 |
9,296 |
$158K |
| D1120 |
Prophylaxis - child |
3,567 |
3,533 |
$134K |
| D0120 |
Periodic oral evaluation - established patient |
4,504 |
4,454 |
$115K |
| D0274 |
Bitewings - four radiographic images |
4,930 |
4,890 |
$115K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,976 |
1,299 |
$100K |
| D0140 |
Limited oral evaluation - problem focused |
2,863 |
2,833 |
$91K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,137 |
638 |
$89K |
| D4910 |
|
1,266 |
1,238 |
$78K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
956 |
663 |
$77K |
| D0220 |
Intraoral - periapical first radiographic image |
6,619 |
6,534 |
$69K |
| D0210 |
Intraoral - complete series of radiographic images |
1,243 |
1,230 |
$59K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,845 |
5,784 |
$41K |
| D2331 |
|
168 |
107 |
$11K |
| D4355 |
|
181 |
180 |
$10K |
| D4341 |
|
99 |
49 |
$8K |
| D0272 |
Bitewings - two radiographic images |
118 |
117 |
$2K |
| D2394 |
|
16 |
14 |
$1K |
| D0603 |
|
33 |
33 |
$320.00 |
| D0602 |
|
17 |
17 |
$150.00 |