| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,013 |
1,079 |
$188K |
| D1120 |
Prophylaxis - child |
3,728 |
3,229 |
$93K |
| D0140 |
Limited oral evaluation - problem focused |
2,630 |
2,214 |
$86K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,119 |
611 |
$77K |
| D0330 |
Panoramic radiographic image |
2,240 |
1,822 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,915 |
1,584 |
$55K |
| D1206 |
Topical application of fluoride varnish |
2,624 |
2,315 |
$54K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
448 |
278 |
$50K |
| D0274 |
Bitewings - four radiographic images |
2,374 |
2,046 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
2,050 |
1,804 |
$46K |
| D7140 |
Extraction, erupted tooth or exposed root |
644 |
251 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
2,911 |
2,318 |
$26K |
| D1351 |
Sealant - per tooth |
1,042 |
165 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
456 |
402 |
$7K |
| D0272 |
Bitewings - two radiographic images |
279 |
225 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
61 |
61 |
$4K |
| D1110 |
Prophylaxis - adult |
406 |
318 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
198 |
131 |
$2K |
| D0270 |
|
42 |
26 |
$162.03 |
| D1999 |
|
19 |
19 |
$0.00 |