| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,605 |
2,211 |
$355K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,148 |
1,885 |
$236K |
| D1110 |
Prophylaxis - adult |
4,762 |
4,313 |
$161K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,093 |
4,736 |
$116K |
| D0120 |
Periodic oral evaluation - established patient |
4,820 |
4,387 |
$116K |
| D0220 |
Intraoral - periapical first radiographic image |
7,614 |
6,555 |
$102K |
| D0274 |
Bitewings - four radiographic images |
3,049 |
2,743 |
$87K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
630 |
434 |
$74K |
| D0140 |
Limited oral evaluation - problem focused |
2,203 |
1,935 |
$70K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,402 |
1,255 |
$55K |
| D7140 |
Extraction, erupted tooth or exposed root |
934 |
379 |
$55K |
| D2331 |
|
630 |
380 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,430 |
2,221 |
$38K |
| D0330 |
Panoramic radiographic image |
688 |
573 |
$30K |
| D1120 |
Prophylaxis - child |
862 |
785 |
$20K |
| D2335 |
|
188 |
99 |
$15K |
| D0272 |
Bitewings - two radiographic images |
291 |
260 |
$4K |
| D2332 |
|
25 |
14 |
$2K |
| D2330 |
|
38 |
25 |
$2K |
| D4355 |
|
15 |
13 |
$879.72 |
| D1999 |
|
152 |
129 |
$0.00 |
| D0108 |
|
71 |
63 |
$0.00 |