| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,779 |
1,003 |
$187K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,203 |
543 |
$113K |
| D1110 |
Prophylaxis - adult |
2,719 |
2,446 |
$111K |
| D0140 |
Limited oral evaluation - problem focused |
2,282 |
1,935 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
2,806 |
2,592 |
$62K |
| D1206 |
Topical application of fluoride varnish |
2,527 |
2,329 |
$40K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
300 |
211 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,057 |
930 |
$36K |
| D1120 |
Prophylaxis - child |
1,158 |
1,085 |
$34K |
| D0274 |
Bitewings - four radiographic images |
1,209 |
1,133 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
411 |
169 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
1,666 |
1,413 |
$24K |
| D0330 |
Panoramic radiographic image |
391 |
355 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
194 |
108 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
203 |
164 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
368 |
301 |
$5K |
| D2950 |
|
13 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
34 |
32 |
$720.00 |
| D1354 |
|
38 |
23 |
$531.00 |
| D7922 |
|
17 |
12 |
$495.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
60 |
37 |
$410.00 |
| D9986 |
|
315 |
302 |
$0.00 |