| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,447 |
2,060 |
$541K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,762 |
1,599 |
$454K |
| D1110 |
Prophylaxis - adult |
3,839 |
3,372 |
$127K |
| D2394 |
|
782 |
371 |
$113K |
| D0120 |
Periodic oral evaluation - established patient |
4,711 |
4,079 |
$104K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,252 |
3,754 |
$85K |
| D0274 |
Bitewings - four radiographic images |
3,159 |
2,722 |
$85K |
| D0220 |
Intraoral - periapical first radiographic image |
5,074 |
4,280 |
$67K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,440 |
1,230 |
$53K |
| D0330 |
Panoramic radiographic image |
1,246 |
1,010 |
$51K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
710 |
332 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,008 |
1,745 |
$30K |
| D1120 |
Prophylaxis - child |
1,180 |
1,031 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
724 |
607 |
$22K |
| D1206 |
Topical application of fluoride varnish |
774 |
649 |
$10K |
| D0272 |
Bitewings - two radiographic images |
408 |
370 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
56 |
12 |
$4K |
| D1351 |
Sealant - per tooth |
166 |
42 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
28 |
25 |
$813.88 |