| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,190 |
611 |
$118K |
| D1110 |
Prophylaxis - adult |
2,643 |
2,516 |
$95K |
| D0120 |
Periodic oral evaluation - established patient |
3,430 |
3,267 |
$85K |
| D0274 |
Bitewings - four radiographic images |
1,780 |
1,667 |
$52K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
711 |
363 |
$51K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,879 |
2,765 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,129 |
1,056 |
$46K |
| D1120 |
Prophylaxis - child |
1,593 |
1,523 |
$42K |
| D0330 |
Panoramic radiographic image |
884 |
811 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
2,836 |
2,597 |
$40K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,755 |
2,254 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
707 |
646 |
$25K |
| D1351 |
Sealant - per tooth |
418 |
103 |
$9K |
| D0272 |
Bitewings - two radiographic images |
424 |
400 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
59 |
27 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
12 |
$2K |
| D4355 |
|
13 |
12 |
$869.64 |
| D4910 |
|
56 |
54 |
$0.00 |