| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,121 |
1,271 |
$115K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,259 |
1,221 |
$112K |
| D1110 |
Prophylaxis - adult |
2,982 |
2,847 |
$100K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,382 |
884 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
4,913 |
4,761 |
$83K |
| D2335 |
|
796 |
387 |
$77K |
| D2394 |
|
846 |
520 |
$65K |
| D0330 |
Panoramic radiographic image |
1,432 |
1,370 |
$65K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,313 |
3,210 |
$49K |
| D1120 |
Prophylaxis - child |
2,401 |
2,348 |
$47K |
| D2332 |
|
642 |
345 |
$40K |
| D7140 |
Extraction, erupted tooth or exposed root |
662 |
303 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,742 |
1,683 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,276 |
1,215 |
$34K |
| D0210 |
Intraoral - complete series of radiographic images |
465 |
440 |
$27K |
| D1351 |
Sealant - per tooth |
363 |
98 |
$8K |
| D0272 |
Bitewings - two radiographic images |
700 |
682 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
251 |
237 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
688 |
653 |
$3K |
| D2331 |
|
17 |
12 |
$933.24 |
| D2330 |
|
24 |
17 |
$860.32 |
| D0230 |
Intraoral - periapical each additional radiographic image |
58 |
26 |
$346.50 |