| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,733 |
1,275 |
$179K |
| D4910 |
|
1,388 |
1,379 |
$92K |
| D0120 |
Periodic oral evaluation - established patient |
2,984 |
2,953 |
$80K |
| D0140 |
Limited oral evaluation - problem focused |
2,361 |
2,195 |
$78K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,759 |
3,200 |
$70K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,276 |
732 |
$67K |
| D0274 |
Bitewings - four radiographic images |
2,844 |
2,813 |
$56K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,944 |
2,912 |
$54K |
| D4341 |
|
711 |
305 |
$53K |
| D1110 |
Prophylaxis - adult |
993 |
975 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
3,954 |
3,805 |
$38K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
473 |
360 |
$37K |
| D0210 |
Intraoral - complete series of radiographic images |
533 |
533 |
$26K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
265 |
102 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
680 |
675 |
$25K |
| D0330 |
Panoramic radiographic image |
1,113 |
1,097 |
$16K |
| D1120 |
Prophylaxis - child |
244 |
243 |
$9K |
| D2332 |
|
38 |
26 |
$4K |
| D1330 |
|
141 |
140 |
$1K |
| D1999 |
|
164 |
137 |
$1K |
| D0603 |
|
96 |
96 |
$1K |