| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,354 |
625 |
$117K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,372 |
2,447 |
$97K |
| D1110 |
Prophylaxis - adult |
3,155 |
2,270 |
$79K |
| D0140 |
Limited oral evaluation - problem focused |
2,184 |
1,740 |
$62K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,782 |
2,471 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
5,542 |
3,788 |
$53K |
| D0210 |
Intraoral - complete series of radiographic images |
999 |
850 |
$47K |
| D0330 |
Panoramic radiographic image |
1,635 |
1,234 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
2,486 |
1,806 |
$45K |
| D0274 |
Bitewings - four radiographic images |
2,279 |
1,639 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
482 |
266 |
$31K |
| D1206 |
Topical application of fluoride varnish |
2,248 |
1,703 |
$23K |
| D1120 |
Prophylaxis - child |
746 |
540 |
$13K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
54 |
40 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
33 |
26 |
$4K |
| D0272 |
Bitewings - two radiographic images |
205 |
149 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
13 |
$1K |
| D0270 |
|
34 |
28 |
$161.92 |