| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,887 |
909 |
$111K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,897 |
2,105 |
$66K |
| D0210 |
Intraoral - complete series of radiographic images |
615 |
606 |
$41K |
| D1110 |
Prophylaxis - adult |
2,734 |
2,683 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,679 |
1,659 |
$36K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
734 |
440 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
1,243 |
1,215 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
238 |
137 |
$6K |
| D0330 |
Panoramic radiographic image |
100 |
99 |
$6K |
| D2332 |
|
238 |
117 |
$6K |
| D5213 |
|
12 |
12 |
$5K |
| D1330 |
|
3,039 |
2,985 |
$4K |
| D2394 |
|
19 |
12 |
$3K |
| D1999 |
|
95 |
82 |
$3K |
| D1120 |
Prophylaxis - child |
185 |
184 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
52 |
24 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
90 |
87 |
$884.80 |
| D1208 |
Topical application of fluoride, excluding varnish |
3,057 |
3,002 |
$422.51 |
| D0274 |
Bitewings - four radiographic images |
724 |
714 |
$293.64 |
| D0220 |
Intraoral - periapical first radiographic image |
2,332 |
2,283 |
$227.90 |
| D0272 |
Bitewings - two radiographic images |
31 |
30 |
$9.00 |
| D9248 |
|
13 |
13 |
$0.00 |
| D0273 |
|
13 |
12 |
$0.00 |
| D0270 |
|
14 |
13 |
$0.00 |