| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,878 |
1,022 |
$346K |
| D1110 |
Prophylaxis - adult |
3,422 |
2,930 |
$174K |
| D0120 |
Periodic oral evaluation - established patient |
4,031 |
3,296 |
$120K |
| D1120 |
Prophylaxis - child |
1,917 |
1,514 |
$77K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
281 |
188 |
$66K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,687 |
2,098 |
$62K |
| D0210 |
Intraoral - complete series of radiographic images |
822 |
765 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,338 |
1,124 |
$58K |
| D0274 |
Bitewings - four radiographic images |
1,451 |
1,231 |
$53K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
233 |
145 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
1,247 |
1,057 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
247 |
226 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
47 |
24 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
714 |
585 |
$8K |
| D9920 |
|
33 |
24 |
$4K |
| D1206 |
Topical application of fluoride varnish |
165 |
144 |
$4K |
| D0330 |
Panoramic radiographic image |
45 |
39 |
$3K |
| D0272 |
Bitewings - two radiographic images |
88 |
63 |
$2K |
| D0602 |
|
2,745 |
2,237 |
$0.00 |
| D0603 |
|
18 |
13 |
$0.00 |
| D0601 |
|
18 |
14 |
$0.00 |