| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,139 |
1,750 |
$146K |
| D1110 |
Prophylaxis - adult |
3,762 |
3,409 |
$119K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,749 |
4,348 |
$107K |
| D0330 |
Panoramic radiographic image |
3,175 |
2,902 |
$102K |
| D4341 |
|
1,817 |
700 |
$94K |
| D1120 |
Prophylaxis - child |
2,087 |
1,986 |
$87K |
| D0274 |
Bitewings - four radiographic images |
4,304 |
3,923 |
$83K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,754 |
1,018 |
$65K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,032 |
844 |
$64K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,197 |
815 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
2,776 |
2,533 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
1,240 |
1,121 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,055 |
1,944 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
5,763 |
3,454 |
$23K |
| D0272 |
Bitewings - two radiographic images |
494 |
461 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
105 |
76 |
$5K |
| D2331 |
|
102 |
67 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,405 |
577 |
$4K |
| D0270 |
|
571 |
526 |
$2K |
| D2332 |
|
48 |
27 |
$2K |
| D2335 |
|
26 |
14 |
$1K |
| D9110 |
|
92 |
81 |
$1K |
| D2330 |
|
23 |
14 |
$798.16 |
| D1206 |
Topical application of fluoride varnish |
13 |
13 |
$148.50 |