| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,437 |
1,531 |
$283K |
| D1120 |
Prophylaxis - child |
5,777 |
5,070 |
$226K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,160 |
1,427 |
$202K |
| D0330 |
Panoramic radiographic image |
3,326 |
2,918 |
$201K |
| D1110 |
Prophylaxis - adult |
3,333 |
2,979 |
$177K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,622 |
7,583 |
$176K |
| D0120 |
Periodic oral evaluation - established patient |
6,709 |
5,915 |
$168K |
| D0274 |
Bitewings - four radiographic images |
2,857 |
2,524 |
$99K |
| D0272 |
Bitewings - two radiographic images |
3,098 |
2,717 |
$77K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,043 |
1,825 |
$70K |
| D0140 |
Limited oral evaluation - problem focused |
1,887 |
1,742 |
$67K |
| D0220 |
Intraoral - periapical first radiographic image |
3,692 |
3,099 |
$53K |
| D7140 |
Extraction, erupted tooth or exposed root |
420 |
263 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,064 |
2,436 |
$33K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
81 |
64 |
$12K |
| D9986 |
|
15 |
15 |
$0.00 |