| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,603 |
1,944 |
$217K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,674 |
3,699 |
$143K |
| D1110 |
Prophylaxis - adult |
5,006 |
4,337 |
$137K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,642 |
1,382 |
$137K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,637 |
6,820 |
$133K |
| D1120 |
Prophylaxis - child |
3,040 |
2,788 |
$122K |
| D0274 |
Bitewings - four radiographic images |
4,095 |
3,632 |
$111K |
| D0210 |
Intraoral - complete series of radiographic images |
2,405 |
2,102 |
$107K |
| D0120 |
Periodic oral evaluation - established patient |
4,306 |
3,925 |
$97K |
| D0140 |
Limited oral evaluation - problem focused |
3,378 |
2,870 |
$78K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
901 |
612 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
4,606 |
3,902 |
$45K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
461 |
295 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,792 |
1,634 |
$24K |
| D1351 |
Sealant - per tooth |
594 |
146 |
$21K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
367 |
105 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
156 |
72 |
$9K |
| D2140 |
|
100 |
71 |
$5K |
| D2160 |
|
59 |
38 |
$3K |
| D7250 |
|
50 |
13 |
$3K |
| D2330 |
|
70 |
40 |
$3K |
| D0272 |
Bitewings - two radiographic images |
137 |
118 |
$3K |
| D0270 |
|
366 |
325 |
$2K |
| D2394 |
|
15 |
14 |
$2K |
| D2331 |
|
24 |
14 |
$1K |
| D0602 |
|
42 |
24 |
$0.00 |