| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,495 |
1,776 |
$471K |
| D1110 |
Prophylaxis - adult |
5,506 |
5,298 |
$200K |
| D0120 |
Periodic oral evaluation - established patient |
7,041 |
6,786 |
$172K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,916 |
786 |
$152K |
| D0274 |
Bitewings - four radiographic images |
3,795 |
3,631 |
$112K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
853 |
446 |
$111K |
| D0330 |
Panoramic radiographic image |
2,193 |
2,110 |
$90K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,727 |
1,661 |
$73K |
| D1120 |
Prophylaxis - child |
2,088 |
2,032 |
$56K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,350 |
3,246 |
$54K |
| D0140 |
Limited oral evaluation - problem focused |
1,603 |
1,477 |
$53K |
| D0220 |
Intraoral - periapical first radiographic image |
2,344 |
2,178 |
$34K |
| D2394 |
|
199 |
67 |
$31K |
| D1206 |
Topical application of fluoride varnish |
1,691 |
1,614 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,353 |
935 |
$16K |
| D0272 |
Bitewings - two radiographic images |
745 |
714 |
$13K |
| D2335 |
|
87 |
36 |
$11K |
| D4355 |
|
69 |
67 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
61 |
24 |
$4K |
| D4341 |
|
29 |
12 |
$2K |
| D2331 |
|
21 |
12 |
$1K |
| D1999 |
|
195 |
175 |
$0.00 |