| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,309 |
1,290 |
$160K |
| D1110 |
Prophylaxis - adult |
4,010 |
3,958 |
$144K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,516 |
848 |
$88K |
| D0120 |
Periodic oral evaluation - established patient |
4,627 |
4,594 |
$75K |
| D0274 |
Bitewings - four radiographic images |
2,906 |
2,874 |
$64K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,262 |
3,242 |
$61K |
| D1120 |
Prophylaxis - child |
1,352 |
1,345 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
4,463 |
4,257 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,418 |
1,360 |
$35K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
358 |
266 |
$35K |
| D8670 |
Periodic orthodontic treatment visit |
74 |
74 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,161 |
2,818 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
900 |
855 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
644 |
608 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
107 |
54 |
$11K |
| D9310 |
|
130 |
130 |
$9K |
| D0330 |
Panoramic radiographic image |
63 |
63 |
$4K |
| D9630 |
|
94 |
89 |
$2K |
| D0272 |
Bitewings - two radiographic images |
18 |
18 |
$362.70 |
| D9994 |
|
823 |
821 |
$0.00 |
| D2950 |
|
15 |
12 |
$0.00 |