| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,632 |
2,634 |
$204K |
| D1110 |
Prophylaxis - adult |
4,130 |
3,966 |
$185K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,287 |
6,004 |
$163K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,816 |
2,457 |
$160K |
| D1120 |
Prophylaxis - child |
2,478 |
2,356 |
$120K |
| D0330 |
Panoramic radiographic image |
2,545 |
2,460 |
$107K |
| D0274 |
Bitewings - four radiographic images |
3,679 |
3,523 |
$100K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,306 |
1,048 |
$83K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,524 |
789 |
$69K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,224 |
4,056 |
$65K |
| D0220 |
Intraoral - periapical first radiographic image |
6,829 |
6,450 |
$61K |
| D0140 |
Limited oral evaluation - problem focused |
1,816 |
1,705 |
$56K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,838 |
4,860 |
$55K |
| D2331 |
|
574 |
413 |
$31K |
| D2332 |
|
330 |
229 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
604 |
596 |
$16K |
| D0272 |
Bitewings - two radiographic images |
451 |
420 |
$7K |
| D2335 |
|
52 |
41 |
$4K |
| D2330 |
|
94 |
64 |
$4K |
| D1351 |
Sealant - per tooth |
201 |
69 |
$4K |
| D3110 |
|
153 |
104 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
27 |
24 |
$2K |
| D9110 |
|
16 |
15 |
$356.79 |
| D1206 |
Topical application of fluoride varnish |
17 |
17 |
$240.00 |