| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,916 |
2,608 |
$389K |
| D1110 |
Prophylaxis - adult |
5,910 |
5,578 |
$212K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,884 |
1,947 |
$210K |
| D0120 |
Periodic oral evaluation - established patient |
8,785 |
8,297 |
$210K |
| D0140 |
Limited oral evaluation - problem focused |
3,852 |
3,592 |
$132K |
| D0330 |
Panoramic radiographic image |
2,560 |
2,401 |
$118K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
948 |
726 |
$111K |
| D0274 |
Bitewings - four radiographic images |
3,830 |
3,613 |
$111K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,827 |
6,502 |
$110K |
| D1120 |
Prophylaxis - child |
3,871 |
3,713 |
$101K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,889 |
1,794 |
$78K |
| D0220 |
Intraoral - periapical first radiographic image |
4,754 |
4,368 |
$65K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,045 |
2,100 |
$46K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
416 |
202 |
$43K |
| D1351 |
Sealant - per tooth |
1,423 |
291 |
$36K |
| D4355 |
|
454 |
435 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,578 |
1,519 |
$27K |
| D2335 |
|
147 |
98 |
$17K |
| D2332 |
|
133 |
85 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
192 |
113 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
93 |
80 |
$4K |
| D2330 |
|
70 |
45 |
$3K |
| D2331 |
|
36 |
14 |
$3K |
| D1206 |
Topical application of fluoride varnish |
14 |
14 |
$198.25 |