| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,295 |
1,395 |
$219K |
| D1110 |
Prophylaxis - adult |
3,529 |
3,529 |
$177K |
| D1120 |
Prophylaxis - child |
3,778 |
3,778 |
$132K |
| D0120 |
Periodic oral evaluation - established patient |
5,357 |
5,357 |
$122K |
| D0272 |
Bitewings - two radiographic images |
6,203 |
6,203 |
$117K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,427 |
994 |
$108K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,048 |
5,048 |
$82K |
| D0330 |
Panoramic radiographic image |
1,716 |
1,716 |
$82K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,558 |
1,558 |
$63K |
| D0140 |
Limited oral evaluation - problem focused |
725 |
722 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
907 |
888 |
$11K |
| D7111 |
|
62 |
39 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
31 |
24 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
65 |
65 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
14 |
$2K |