| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,656 |
2,594 |
$328K |
| D0274 |
Bitewings - four radiographic images |
10,921 |
10,805 |
$314K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,307 |
8,226 |
$284K |
| D1120 |
Prophylaxis - child |
7,485 |
7,421 |
$234K |
| D1110 |
Prophylaxis - adult |
3,339 |
3,308 |
$147K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,156 |
8,068 |
$145K |
| D0220 |
Intraoral - periapical first radiographic image |
12,638 |
12,347 |
$139K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,887 |
1,140 |
$100K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,464 |
10,207 |
$93K |
| D0120 |
Periodic oral evaluation - established patient |
3,504 |
3,465 |
$74K |
| D0330 |
Panoramic radiographic image |
1,182 |
1,173 |
$56K |
| D0140 |
Limited oral evaluation - problem focused |
1,844 |
1,804 |
$54K |
| D7140 |
Extraction, erupted tooth or exposed root |
347 |
165 |
$22K |
| D4346 |
|
162 |
160 |
$20K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
157 |
70 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
123 |
84 |
$11K |
| D2331 |
|
101 |
59 |
$9K |
| D1206 |
Topical application of fluoride varnish |
297 |
294 |
$6K |
| D1351 |
Sealant - per tooth |
120 |
31 |
$3K |
| D1999 |
|
70 |
55 |
$0.00 |