| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,647 |
931 |
$184K |
| D0330 |
Panoramic radiographic image |
2,654 |
2,467 |
$149K |
| D1110 |
Prophylaxis - adult |
2,570 |
2,372 |
$134K |
| D0140 |
Limited oral evaluation - problem focused |
3,132 |
2,870 |
$107K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
988 |
521 |
$92K |
| D0120 |
Periodic oral evaluation - established patient |
3,454 |
3,118 |
$86K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,111 |
562 |
$83K |
| D0274 |
Bitewings - four radiographic images |
2,081 |
1,938 |
$73K |
| D1120 |
Prophylaxis - child |
1,827 |
1,634 |
$67K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,305 |
2,014 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
2,792 |
2,481 |
$42K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
224 |
158 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
780 |
732 |
$28K |
| D1351 |
Sealant - per tooth |
983 |
171 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,387 |
1,124 |
$27K |
| D9630 |
|
1,023 |
900 |
$22K |
| D1206 |
Topical application of fluoride varnish |
538 |
527 |
$12K |
| D2335 |
|
44 |
30 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
25 |
15 |
$3K |
| D2332 |
|
19 |
13 |
$2K |
| D0180 |
|
37 |
36 |
$2K |
| D0272 |
Bitewings - two radiographic images |
23 |
19 |
$658.69 |
| D1310 |
|
57 |
56 |
$0.00 |
| D1330 |
|
55 |
55 |
$0.00 |