| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,955 |
2,144 |
$190K |
| D0120 |
Periodic oral evaluation - established patient |
5,444 |
5,065 |
$146K |
| D1120 |
Prophylaxis - child |
3,608 |
3,400 |
$144K |
| D1110 |
Prophylaxis - adult |
2,533 |
2,398 |
$100K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,218 |
3,012 |
$81K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,648 |
3,465 |
$79K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,886 |
1,424 |
$76K |
| D0210 |
Intraoral - complete series of radiographic images |
2,499 |
2,351 |
$68K |
| D4341 |
|
348 |
176 |
$64K |
| D0274 |
Bitewings - four radiographic images |
4,206 |
3,942 |
$60K |
| D4342 |
|
476 |
237 |
$60K |
| D1351 |
Sealant - per tooth |
864 |
472 |
$58K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,020 |
750 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
7,162 |
6,655 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,649 |
5,738 |
$36K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
422 |
315 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
1,203 |
1,148 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
276 |
217 |
$17K |
| D2331 |
|
127 |
105 |
$8K |
| D4910 |
|
106 |
102 |
$6K |
| D2740 |
Crown - porcelain/ceramic |
14 |
12 |
$3K |
| D0272 |
Bitewings - two radiographic images |
375 |
343 |
$3K |
| D2330 |
|
78 |
54 |
$3K |
| D0330 |
Panoramic radiographic image |
30 |
30 |
$706.89 |
| D0270 |
|
122 |
117 |
$666.40 |
| D1999 |
|
23 |
22 |
$0.00 |