| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,993 |
1,698 |
$234K |
| D1120 |
Prophylaxis - child |
3,635 |
3,611 |
$160K |
| D0120 |
Periodic oral evaluation - established patient |
4,935 |
4,886 |
$139K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,843 |
1,093 |
$117K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,602 |
4,537 |
$114K |
| D0274 |
Bitewings - four radiographic images |
1,501 |
1,480 |
$48K |
| D1110 |
Prophylaxis - adult |
1,279 |
1,251 |
$40K |
| D0330 |
Panoramic radiographic image |
527 |
520 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
581 |
536 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
425 |
416 |
$23K |
| D0272 |
Bitewings - two radiographic images |
548 |
545 |
$16K |
| D1351 |
Sealant - per tooth |
277 |
94 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
361 |
355 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
108 |
84 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
662 |
644 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
106 |
48 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
28 |
15 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
81 |
24 |
$468.52 |
| D3120 |
|
18 |
12 |
$0.00 |