| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16,273 |
4,237 |
$1.29M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,919 |
2,410 |
$578K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,405 |
1,915 |
$412K |
| D1120 |
Prophylaxis - child |
11,049 |
10,690 |
$301K |
| D0120 |
Periodic oral evaluation - established patient |
14,542 |
14,069 |
$264K |
| D0330 |
Panoramic radiographic image |
6,111 |
5,783 |
$247K |
| D1208 |
Topical application of fluoride, excluding varnish |
17,596 |
16,921 |
$246K |
| D1110 |
Prophylaxis - adult |
6,548 |
6,261 |
$231K |
| D0140 |
Limited oral evaluation - problem focused |
7,259 |
6,865 |
$201K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,552 |
2,106 |
$193K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,072 |
2,885 |
$73K |
| D0272 |
Bitewings - two radiographic images |
3,603 |
3,469 |
$61K |
| D3110 |
|
968 |
593 |
$24K |
| D2332 |
|
175 |
66 |
$14K |
| D2394 |
|
59 |
38 |
$6K |
| D2335 |
|
17 |
12 |
$2K |
| D9110 |
|
12 |
12 |
$440.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
265 |
205 |
$0.00 |