| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,968 |
869 |
$149K |
| D1120 |
Prophylaxis - child |
2,617 |
2,487 |
$109K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,086 |
3,869 |
$92K |
| D0120 |
Periodic oral evaluation - established patient |
3,379 |
3,227 |
$84K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,630 |
1,471 |
$70K |
| D1110 |
Prophylaxis - adult |
2,001 |
1,899 |
$61K |
| D0210 |
Intraoral - complete series of radiographic images |
963 |
905 |
$56K |
| D0140 |
Limited oral evaluation - problem focused |
1,674 |
1,536 |
$44K |
| D0274 |
Bitewings - four radiographic images |
1,314 |
1,262 |
$40K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
275 |
154 |
$26K |
| D2991 |
|
453 |
50 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
347 |
175 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,415 |
1,278 |
$16K |
| D0330 |
Panoramic radiographic image |
336 |
276 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
257 |
77 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
80 |
42 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
351 |
201 |
$4K |
| D0272 |
Bitewings - two radiographic images |
105 |
104 |
$3K |
| D1310 |
|
652 |
607 |
$0.00 |
| D1330 |
|
672 |
628 |
$0.00 |