| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,793 |
1,083 |
$271K |
| D0120 |
Periodic oral evaluation - established patient |
5,016 |
4,983 |
$121K |
| D1206 |
Topical application of fluoride varnish |
5,414 |
5,379 |
$113K |
| D1110 |
Prophylaxis - adult |
2,657 |
2,635 |
$108K |
| D1120 |
Prophylaxis - child |
2,946 |
2,921 |
$95K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,471 |
550 |
$87K |
| D0274 |
Bitewings - four radiographic images |
2,065 |
2,053 |
$31K |
| D0272 |
Bitewings - two radiographic images |
2,724 |
2,704 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
406 |
403 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
754 |
746 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
871 |
851 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
389 |
294 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
728 |
670 |
$8K |
| D3221 |
|
33 |
26 |
$3K |
| D2335 |
|
21 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
46 |
45 |
$2K |
| D2940 |
|
20 |
14 |
$48.75 |