| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,973 |
1,332 |
$211K |
| D0120 |
Periodic oral evaluation - established patient |
5,131 |
4,732 |
$145K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,175 |
944 |
$142K |
| D1110 |
Prophylaxis - adult |
3,201 |
3,010 |
$139K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,398 |
992 |
$120K |
| D0330 |
Panoramic radiographic image |
1,441 |
1,333 |
$94K |
| D0140 |
Limited oral evaluation - problem focused |
2,205 |
2,023 |
$88K |
| D1120 |
Prophylaxis - child |
2,375 |
2,227 |
$74K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,021 |
3,751 |
$74K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,466 |
1,328 |
$69K |
| D0272 |
Bitewings - two radiographic images |
2,827 |
2,615 |
$57K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
266 |
208 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
1,831 |
1,656 |
$30K |
| D0274 |
Bitewings - four radiographic images |
431 |
415 |
$16K |
| D2331 |
|
110 |
66 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
241 |
138 |
$3K |
| D2330 |
|
14 |
12 |
$1K |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$224.77 |