| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,219 |
895 |
$133K |
| D1110 |
Prophylaxis - adult |
2,456 |
2,107 |
$67K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
950 |
452 |
$65K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,411 |
3,005 |
$56K |
| D0210 |
Intraoral - complete series of radiographic images |
1,168 |
997 |
$51K |
| D0274 |
Bitewings - four radiographic images |
1,871 |
1,655 |
$48K |
| D0120 |
Periodic oral evaluation - established patient |
2,175 |
1,957 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,552 |
1,156 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
1,656 |
1,353 |
$36K |
| D1120 |
Prophylaxis - child |
901 |
841 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
1,629 |
1,369 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
326 |
149 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
314 |
77 |
$11K |
| D2394 |
|
64 |
42 |
$7K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
22 |
14 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
87 |
28 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
518 |
261 |
$4K |
| D2335 |
|
41 |
18 |
$4K |
| D0330 |
Panoramic radiographic image |
253 |
183 |
$3K |
| D8660 |
|
333 |
186 |
$3K |
| D0270 |
|
116 |
104 |
$666.40 |
| D0272 |
Bitewings - two radiographic images |
19 |
13 |
$216.32 |
| D0603 |
|
34 |
21 |
$0.00 |