| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,607 |
1,737 |
$259K |
| D1110 |
Prophylaxis - adult |
4,653 |
4,551 |
$192K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,845 |
1,567 |
$170K |
| D1206 |
Topical application of fluoride varnish |
4,307 |
4,245 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
3,626 |
3,569 |
$86K |
| D0274 |
Bitewings - four radiographic images |
3,002 |
2,937 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,836 |
1,795 |
$50K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
518 |
281 |
$42K |
| D0330 |
Panoramic radiographic image |
1,047 |
1,018 |
$40K |
| D7140 |
Extraction, erupted tooth or exposed root |
353 |
88 |
$23K |
| D1120 |
Prophylaxis - child |
718 |
700 |
$23K |
| D2740 |
Crown - porcelain/ceramic |
19 |
13 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
731 |
687 |
$8K |
| D0272 |
Bitewings - two radiographic images |
228 |
223 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
181 |
172 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
127 |
121 |
$3K |
| D2331 |
|
23 |
14 |
$1K |
| D1999 |
|
196 |
181 |
$0.00 |