| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,749 |
2,737 |
$287K |
| D1110 |
Prophylaxis - adult |
6,437 |
6,437 |
$268K |
| D0120 |
Periodic oral evaluation - established patient |
8,298 |
8,298 |
$187K |
| D2394 |
|
1,303 |
1,124 |
$131K |
| D0274 |
Bitewings - four radiographic images |
5,644 |
5,644 |
$125K |
| D0210 |
Intraoral - complete series of radiographic images |
2,437 |
2,436 |
$103K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,066 |
941 |
$70K |
| D1120 |
Prophylaxis - child |
1,789 |
1,789 |
$66K |
| D0220 |
Intraoral - periapical first radiographic image |
5,988 |
5,979 |
$53K |
| D2750 |
|
107 |
95 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,097 |
3,097 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,761 |
5,760 |
$30K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
338 |
305 |
$28K |
| D2335 |
|
62 |
44 |
$7K |
| D2330 |
|
115 |
63 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
277 |
276 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
26 |
26 |
$2K |
| D2954 |
|
14 |
13 |
$2K |
| D1206 |
Topical application of fluoride varnish |
20 |
20 |
$540.50 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
17 |
17 |
$465.60 |