| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,849 |
4,014 |
$716K |
| D1110 |
Prophylaxis - adult |
11,535 |
11,217 |
$436K |
| D0120 |
Periodic oral evaluation - established patient |
15,435 |
15,083 |
$395K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,001 |
1,776 |
$237K |
| D1120 |
Prophylaxis - child |
6,344 |
6,166 |
$173K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,043 |
3,812 |
$168K |
| D0220 |
Intraoral - periapical first radiographic image |
11,079 |
10,522 |
$165K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,180 |
830 |
$149K |
| D0274 |
Bitewings - four radiographic images |
4,716 |
4,590 |
$148K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,783 |
8,301 |
$142K |
| D1206 |
Topical application of fluoride varnish |
7,049 |
6,919 |
$116K |
| D0330 |
Panoramic radiographic image |
1,938 |
1,868 |
$111K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,164 |
4,986 |
$86K |
| D0210 |
Intraoral - complete series of radiographic images |
964 |
900 |
$64K |
| D0140 |
Limited oral evaluation - problem focused |
1,681 |
1,573 |
$58K |
| D0272 |
Bitewings - two radiographic images |
1,818 |
1,778 |
$34K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
245 |
78 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
212 |
88 |
$13K |
| D1351 |
Sealant - per tooth |
347 |
100 |
$10K |
| D4341 |
|
87 |
34 |
$9K |
| D4355 |
|
117 |
113 |
$7K |
| D2394 |
|
32 |
26 |
$5K |
| D2335 |
|
19 |
12 |
$2K |
| D2332 |
|
18 |
12 |
$2K |
| D3120 |
|
37 |
29 |
$0.00 |