| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,638 |
1,979 |
$259K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,392 |
1,638 |
$184K |
| D0120 |
Periodic oral evaluation - established patient |
6,006 |
5,791 |
$167K |
| D1120 |
Prophylaxis - child |
5,041 |
4,838 |
$165K |
| D1110 |
Prophylaxis - adult |
2,766 |
2,686 |
$115K |
| D1206 |
Topical application of fluoride varnish |
6,957 |
6,694 |
$107K |
| D7140 |
Extraction, erupted tooth or exposed root |
884 |
541 |
$74K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,122 |
1,081 |
$57K |
| D0140 |
Limited oral evaluation - problem focused |
1,767 |
1,662 |
$54K |
| D0274 |
Bitewings - four radiographic images |
1,732 |
1,673 |
$49K |
| D1354 |
|
1,351 |
543 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
1,842 |
1,706 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,036 |
1,011 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
242 |
242 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
797 |
779 |
$9K |
| D0240 |
|
873 |
616 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
316 |
315 |
$6K |
| D1330 |
|
121 |
117 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
14 |
$1K |
| D1320 |
|
52 |
52 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
68 |
38 |
$666.25 |
| D0190 |
|
44 |
41 |
$0.00 |