| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
960 |
397 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,139 |
1,974 |
$47K |
| D1110 |
Prophylaxis - adult |
1,342 |
1,311 |
$38K |
| D0210 |
Intraoral - complete series of radiographic images |
1,501 |
1,166 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
537 |
287 |
$33K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
309 |
133 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,049 |
981 |
$23K |
| D0330 |
Panoramic radiographic image |
538 |
474 |
$21K |
| D2950 |
|
148 |
93 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
680 |
635 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,406 |
1,226 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
975 |
587 |
$7K |
| D1206 |
Topical application of fluoride varnish |
465 |
460 |
$6K |
| D9630 |
|
761 |
754 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
599 |
589 |
$5K |
| D1351 |
Sealant - per tooth |
114 |
31 |
$4K |
| D1120 |
Prophylaxis - child |
55 |
55 |
$2K |
| D9110 |
|
29 |
29 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
31 |
12 |
$1K |
| D0270 |
|
14 |
14 |
$145.34 |
| D9994 |
|
562 |
558 |
$0.00 |
| D1999 |
|
113 |
50 |
$0.00 |