| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,397 |
531 |
$110K |
| D0120 |
Periodic oral evaluation - established patient |
1,546 |
1,519 |
$38K |
| D1120 |
Prophylaxis - child |
795 |
787 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
495 |
222 |
$30K |
| D1110 |
Prophylaxis - adult |
923 |
900 |
$28K |
| D0274 |
Bitewings - four radiographic images |
790 |
776 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,048 |
1,033 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
877 |
806 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
221 |
143 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
141 |
140 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
518 |
485 |
$5K |
| D2394 |
|
34 |
26 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
70 |
69 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
21 |
13 |
$2K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
22 |
12 |
$176.80 |