| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,070 |
1,619 |
$209K |
| D0120 |
Periodic oral evaluation - established patient |
4,833 |
4,786 |
$116K |
| D1110 |
Prophylaxis - adult |
2,639 |
2,586 |
$110K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,826 |
4,780 |
$100K |
| D1120 |
Prophylaxis - child |
2,836 |
2,817 |
$93K |
| D0274 |
Bitewings - four radiographic images |
2,206 |
2,172 |
$56K |
| D0210 |
Intraoral - complete series of radiographic images |
319 |
310 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
156 |
111 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
430 |
409 |
$11K |
| D0272 |
Bitewings - two radiographic images |
575 |
574 |
$10K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
16 |
14 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
717 |
673 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
116 |
81 |
$6K |
| D0330 |
Panoramic radiographic image |
152 |
149 |
$6K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
38 |
26 |
$4K |
| D4355 |
|
69 |
67 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
23 |
13 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
61 |
61 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17 |
14 |
$167.45 |
| D1999 |
|
32 |
30 |
$0.00 |