| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,904 |
1,841 |
$427K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,084 |
1,060 |
$159K |
| D1120 |
Prophylaxis - child |
6,356 |
5,577 |
$141K |
| D0120 |
Periodic oral evaluation - established patient |
7,119 |
6,206 |
$138K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,481 |
5,958 |
$99K |
| D1110 |
Prophylaxis - adult |
1,970 |
1,690 |
$73K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,006 |
541 |
$61K |
| D1206 |
Topical application of fluoride varnish |
1,637 |
1,105 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,594 |
1,396 |
$36K |
| D0272 |
Bitewings - two radiographic images |
2,705 |
2,370 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
970 |
843 |
$28K |
| D2160 |
|
145 |
92 |
$9K |
| D2335 |
|
118 |
69 |
$8K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
122 |
68 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
60 |
39 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
85 |
42 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
195 |
188 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
551 |
491 |
$3K |
| D2331 |
|
31 |
12 |
$866.58 |
| D2330 |
|
19 |
14 |
$409.68 |