| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,288 |
1,928 |
$299K |
| D0120 |
Periodic oral evaluation - established patient |
3,508 |
3,471 |
$70K |
| D1110 |
Prophylaxis - adult |
3,451 |
3,405 |
$69K |
| D1120 |
Prophylaxis - child |
1,408 |
1,397 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,274 |
1,253 |
$26K |
| D0274 |
Bitewings - four radiographic images |
2,380 |
2,348 |
$25K |
| D1206 |
Topical application of fluoride varnish |
2,036 |
2,022 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
4,864 |
4,700 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
1,032 |
986 |
$20K |
| D2750 |
|
41 |
36 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,691 |
4,156 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
485 |
481 |
$14K |
| D0272 |
Bitewings - two radiographic images |
1,425 |
1,408 |
$9K |
| D2331 |
|
137 |
72 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
143 |
83 |
$6K |
| D2952 |
|
57 |
48 |
$5K |
| D9110 |
|
424 |
408 |
$4K |
| D2332 |
|
28 |
13 |
$1K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
32 |
24 |
$1K |
| D0270 |
|
15 |
15 |
$61.80 |