| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,771 |
1,518 |
$451K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,028 |
1,617 |
$367K |
| D1120 |
Prophylaxis - child |
3,748 |
3,746 |
$148K |
| D0120 |
Periodic oral evaluation - established patient |
5,110 |
5,104 |
$132K |
| D0140 |
Limited oral evaluation - problem focused |
3,092 |
2,933 |
$114K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,521 |
4,519 |
$103K |
| D1110 |
Prophylaxis - adult |
2,371 |
2,363 |
$100K |
| D7140 |
Extraction, erupted tooth or exposed root |
937 |
651 |
$76K |
| D0274 |
Bitewings - four radiographic images |
2,112 |
2,109 |
$61K |
| D0220 |
Intraoral - periapical first radiographic image |
2,959 |
2,852 |
$39K |
| D2332 |
|
270 |
200 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,499 |
1,822 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
918 |
916 |
$31K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
217 |
122 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
146 |
90 |
$19K |
| D0272 |
Bitewings - two radiographic images |
825 |
825 |
$19K |
| D1351 |
Sealant - per tooth |
329 |
94 |
$10K |
| D4355 |
|
133 |
131 |
$9K |
| D2330 |
|
95 |
64 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$1K |
| D9995 |
|
238 |
235 |
$0.00 |