| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,097 |
529 |
$105K |
| D0120 |
Periodic oral evaluation - established patient |
1,823 |
1,743 |
$44K |
| D1110 |
Prophylaxis - adult |
1,251 |
1,179 |
$43K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
523 |
309 |
$38K |
| D0330 |
Panoramic radiographic image |
622 |
571 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
739 |
671 |
$29K |
| D1120 |
Prophylaxis - child |
1,114 |
1,059 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,653 |
1,569 |
$26K |
| D0274 |
Bitewings - four radiographic images |
893 |
842 |
$26K |
| D0272 |
Bitewings - two radiographic images |
402 |
366 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
457 |
402 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
39 |
24 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
125 |
116 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
41 |
13 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
149 |
77 |
$2K |
| D1206 |
Topical application of fluoride varnish |
14 |
14 |
$246.54 |
| D1999 |
|
573 |
506 |
$0.00 |