| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,317 |
1,900 |
$704K |
| D1110 |
Prophylaxis - adult |
5,032 |
4,591 |
$321K |
| D0120 |
Periodic oral evaluation - established patient |
6,855 |
6,253 |
$255K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,201 |
876 |
$211K |
| D1206 |
Topical application of fluoride varnish |
6,130 |
5,601 |
$183K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
626 |
457 |
$166K |
| D1120 |
Prophylaxis - child |
2,940 |
2,696 |
$143K |
| D0274 |
Bitewings - four radiographic images |
2,855 |
2,593 |
$132K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,889 |
1,697 |
$113K |
| D0210 |
Intraoral - complete series of radiographic images |
848 |
770 |
$75K |
| D0140 |
Limited oral evaluation - problem focused |
1,332 |
1,208 |
$72K |
| D0330 |
Panoramic radiographic image |
887 |
797 |
$67K |
| D1351 |
Sealant - per tooth |
2,371 |
555 |
$25K |
| D0272 |
Bitewings - two radiographic images |
663 |
594 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,026 |
938 |
$21K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
50 |
29 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
67 |
38 |
$12K |
| D7250 |
|
22 |
13 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14 |
12 |
$246.40 |
| D9986 |
|
79 |
66 |
$0.00 |
| D0603 |
|
6,895 |
6,288 |
$0.00 |
| D0602 |
|
246 |
240 |
$0.00 |