| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,283 |
1,591 |
$245K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,200 |
1,550 |
$173K |
| D1110 |
Prophylaxis - adult |
3,833 |
3,766 |
$146K |
| D0140 |
Limited oral evaluation - problem focused |
3,626 |
3,256 |
$132K |
| D0120 |
Periodic oral evaluation - established patient |
4,689 |
4,617 |
$119K |
| D0274 |
Bitewings - four radiographic images |
2,004 |
1,961 |
$64K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,260 |
3,213 |
$55K |
| D2330 |
|
661 |
437 |
$43K |
| D1120 |
Prophylaxis - child |
1,302 |
1,280 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
2,294 |
2,145 |
$33K |
| D0330 |
Panoramic radiographic image |
620 |
597 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
503 |
493 |
$22K |
| D2331 |
|
122 |
93 |
$10K |
| D0272 |
Bitewings - two radiographic images |
404 |
394 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
564 |
311 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
86 |
63 |
$5K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
13 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$2K |
| D2332 |
|
20 |
13 |
$2K |
| D1999 |
|
878 |
757 |
$0.00 |