| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,517 |
818 |
$202K |
| D1206 |
Topical application of fluoride varnish |
5,709 |
5,620 |
$143K |
| D1110 |
Prophylaxis - adult |
2,142 |
2,108 |
$135K |
| D1120 |
Prophylaxis - child |
2,854 |
2,809 |
$124K |
| D0120 |
Periodic oral evaluation - established patient |
3,433 |
3,382 |
$102K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
968 |
474 |
$102K |
| D2750 |
|
190 |
152 |
$85K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,452 |
1,434 |
$79K |
| D0140 |
Limited oral evaluation - problem focused |
1,625 |
1,492 |
$75K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
381 |
228 |
$65K |
| D0274 |
Bitewings - four radiographic images |
2,702 |
2,657 |
$61K |
| D3120 |
|
1,730 |
712 |
$60K |
| D1351 |
Sealant - per tooth |
1,706 |
274 |
$56K |
| D0210 |
Intraoral - complete series of radiographic images |
661 |
646 |
$37K |
| D0330 |
Panoramic radiographic image |
705 |
681 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
2,393 |
1,878 |
$26K |
| D2940 |
|
501 |
372 |
$26K |
| D4341 |
|
310 |
107 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,176 |
1,019 |
$13K |
| D1330 |
|
2,083 |
2,039 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
76 |
31 |
$10K |
| D2950 |
|
116 |
100 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
287 |
284 |
$7K |
| D0272 |
Bitewings - two radiographic images |
426 |
423 |
$7K |
| D7510 |
|
126 |
107 |
$6K |
| D0160 |
|
100 |
100 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
38 |
13 |
$3K |
| D4355 |
|
16 |
16 |
$2K |
| D0460 |
|
116 |
115 |
$1K |
| D2951 |
|
65 |
53 |
$736.38 |
| D0270 |
|
20 |
15 |
$135.00 |