| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
843 |
467 |
$168K |
| D1110 |
Prophylaxis - adult |
2,852 |
2,514 |
$164K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,171 |
1,903 |
$106K |
| D0274 |
Bitewings - four radiographic images |
1,978 |
1,815 |
$87K |
| D0120 |
Periodic oral evaluation - established patient |
1,958 |
1,800 |
$71K |
| D0210 |
Intraoral - complete series of radiographic images |
917 |
810 |
$63K |
| D7140 |
Extraction, erupted tooth or exposed root |
522 |
261 |
$63K |
| D1206 |
Topical application of fluoride varnish |
1,590 |
1,515 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
2,237 |
2,054 |
$48K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
211 |
146 |
$45K |
| D1120 |
Prophylaxis - child |
623 |
594 |
$32K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
69 |
54 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,487 |
920 |
$17K |
| D0330 |
Panoramic radiographic image |
197 |
183 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
297 |
261 |
$15K |
| D0272 |
Bitewings - two radiographic images |
174 |
165 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
35 |
13 |
$4K |
| D0601 |
|
1,815 |
1,690 |
$0.00 |