| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,391 |
1,491 |
$155K |
| D1110 |
Prophylaxis - adult |
3,621 |
3,445 |
$148K |
| D0120 |
Periodic oral evaluation - established patient |
4,207 |
4,029 |
$77K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,540 |
895 |
$73K |
| D0274 |
Bitewings - four radiographic images |
2,119 |
1,977 |
$63K |
| D1120 |
Prophylaxis - child |
1,903 |
1,817 |
$48K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
494 |
370 |
$46K |
| D7140 |
Extraction, erupted tooth or exposed root |
576 |
287 |
$42K |
| D1206 |
Topical application of fluoride varnish |
2,074 |
1,972 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,334 |
1,226 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
902 |
858 |
$31K |
| D0272 |
Bitewings - two radiographic images |
1,014 |
967 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,041 |
994 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
251 |
231 |
$11K |
| D1351 |
Sealant - per tooth |
411 |
109 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,011 |
919 |
$11K |
| D2331 |
|
38 |
28 |
$4K |
| D0330 |
Panoramic radiographic image |
64 |
59 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
33 |
28 |
$318.00 |