| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,248 |
697 |
$112K |
| D1110 |
Prophylaxis - adult |
3,340 |
2,975 |
$105K |
| D0120 |
Periodic oral evaluation - established patient |
4,403 |
4,004 |
$102K |
| D0140 |
Limited oral evaluation - problem focused |
3,138 |
2,674 |
$102K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,456 |
3,783 |
$91K |
| D0220 |
Intraoral - periapical first radiographic image |
5,810 |
5,055 |
$78K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,963 |
1,731 |
$76K |
| D0274 |
Bitewings - four radiographic images |
2,685 |
2,410 |
$72K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
833 |
487 |
$61K |
| D0330 |
Panoramic radiographic image |
1,504 |
1,340 |
$55K |
| D1120 |
Prophylaxis - child |
2,108 |
1,924 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,875 |
2,610 |
$44K |
| D7140 |
Extraction, erupted tooth or exposed root |
222 |
109 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
98 |
51 |
$11K |
| D0272 |
Bitewings - two radiographic images |
558 |
502 |
$9K |
| D1206 |
Topical application of fluoride varnish |
280 |
247 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
17 |
13 |
$775.39 |
| D9110 |
|
14 |
13 |
$551.22 |
| D0707 |
|
55 |
54 |
$0.00 |
| D0701 |
|
30 |
29 |
$0.00 |
| D1999 |
|
90 |
81 |
$0.00 |