| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,511 |
1,802 |
$311K |
| D1110 |
Prophylaxis - adult |
4,181 |
4,165 |
$213K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,328 |
1,033 |
$199K |
| D0120 |
Periodic oral evaluation - established patient |
5,644 |
5,632 |
$155K |
| D0274 |
Bitewings - four radiographic images |
3,536 |
3,526 |
$116K |
| D1120 |
Prophylaxis - child |
1,979 |
1,979 |
$82K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,972 |
2,971 |
$77K |
| D7140 |
Extraction, erupted tooth or exposed root |
875 |
575 |
$67K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
718 |
543 |
$66K |
| D0140 |
Limited oral evaluation - problem focused |
1,544 |
1,523 |
$64K |
| D0220 |
Intraoral - periapical first radiographic image |
2,185 |
2,121 |
$35K |
| D2740 |
Crown - porcelain/ceramic |
26 |
14 |
$20K |
| D2394 |
|
108 |
88 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
289 |
289 |
$13K |
| D2790 |
|
14 |
12 |
$10K |
| D0330 |
Panoramic radiographic image |
144 |
144 |
$8K |
| D0272 |
Bitewings - two radiographic images |
172 |
172 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
405 |
332 |
$4K |