| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,918 |
903 |
$89K |
| D1110 |
Prophylaxis - adult |
2,001 |
1,811 |
$67K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,331 |
704 |
$49K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
871 |
528 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,953 |
1,769 |
$44K |
| D1120 |
Prophylaxis - child |
842 |
768 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
695 |
621 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,007 |
913 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
1,028 |
932 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
513 |
432 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
942 |
858 |
$13K |
| D2332 |
|
209 |
133 |
$13K |
| D4341 |
|
125 |
53 |
$9K |
| D0330 |
Panoramic radiographic image |
201 |
169 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
182 |
110 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
825 |
682 |
$5K |
| D2394 |
|
38 |
29 |
$3K |
| D2335 |
|
35 |
25 |
$3K |
| D1351 |
Sealant - per tooth |
72 |
12 |
$889.36 |
| D1999 |
|
126 |
102 |
$0.00 |