| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,693 |
1,079 |
$137K |
| D1110 |
Prophylaxis - adult |
3,047 |
2,969 |
$131K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,615 |
979 |
$111K |
| D1206 |
Topical application of fluoride varnish |
3,479 |
3,369 |
$69K |
| D0120 |
Periodic oral evaluation - established patient |
3,518 |
3,430 |
$65K |
| D0274 |
Bitewings - four radiographic images |
2,502 |
2,439 |
$65K |
| D9630 |
|
3,292 |
3,169 |
$63K |
| D1120 |
Prophylaxis - child |
1,904 |
1,841 |
$60K |
| D0210 |
Intraoral - complete series of radiographic images |
1,287 |
1,132 |
$59K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
470 |
372 |
$49K |
| D7140 |
Extraction, erupted tooth or exposed root |
771 |
369 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,625 |
1,566 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
1,226 |
1,166 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
2,447 |
2,270 |
$24K |
| D0330 |
Panoramic radiographic image |
360 |
346 |
$17K |
| D2332 |
|
138 |
97 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,277 |
1,122 |
$12K |
| D4355 |
|
111 |
108 |
$7K |
| D2330 |
|
101 |
65 |
$7K |
| D2331 |
|
93 |
67 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
46 |
16 |
$6K |
| D1351 |
Sealant - per tooth |
128 |
41 |
$4K |
| D9920 |
|
25 |
25 |
$2K |
| D4346 |
|
29 |
29 |
$1K |
| D0272 |
Bitewings - two radiographic images |
32 |
21 |
$314.40 |
| D3120 |
|
14 |
13 |
$0.00 |