| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,331 |
1,337 |
$247K |
| D1110 |
Prophylaxis - adult |
4,401 |
4,144 |
$161K |
| D0330 |
Panoramic radiographic image |
2,634 |
2,472 |
$125K |
| D0120 |
Periodic oral evaluation - established patient |
4,944 |
4,706 |
$120K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,380 |
888 |
$110K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,723 |
686 |
$107K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,309 |
2,183 |
$96K |
| D0140 |
Limited oral evaluation - problem focused |
2,787 |
2,568 |
$93K |
| D0274 |
Bitewings - four radiographic images |
3,120 |
2,933 |
$93K |
| D1120 |
Prophylaxis - child |
2,850 |
2,758 |
$77K |
| D1206 |
Topical application of fluoride varnish |
4,616 |
4,443 |
$73K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
435 |
277 |
$54K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
439 |
238 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
2,949 |
2,685 |
$42K |
| D0272 |
Bitewings - two radiographic images |
1,437 |
1,391 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,013 |
595 |
$11K |
| D4355 |
|
35 |
35 |
$2K |
| D2335 |
|
22 |
12 |
$2K |
| D2331 |
|
24 |
17 |
$2K |
| D2332 |
|
20 |
13 |
$2K |
| D2330 |
|
17 |
12 |
$1K |
| D1999 |
|
1,814 |
1,529 |
$0.00 |