| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,928 |
1,699 |
$220K |
| D1110 |
Prophylaxis - adult |
5,723 |
5,179 |
$212K |
| D0274 |
Bitewings - four radiographic images |
7,845 |
7,079 |
$139K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,640 |
4,182 |
$131K |
| D0120 |
Periodic oral evaluation - established patient |
6,555 |
5,971 |
$124K |
| D0330 |
Panoramic radiographic image |
2,833 |
2,584 |
$116K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,503 |
789 |
$92K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,298 |
439 |
$67K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,152 |
496 |
$61K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,664 |
3,343 |
$61K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,707 |
7,335 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
8,873 |
7,933 |
$44K |
| D1120 |
Prophylaxis - child |
1,919 |
1,773 |
$41K |
| D0240 |
|
3,470 |
1,221 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
601 |
497 |
$30K |
| D2394 |
|
83 |
52 |
$6K |
| D0272 |
Bitewings - two radiographic images |
632 |
601 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
260 |
244 |
$5K |
| D4342 |
|
27 |
12 |
$3K |
| D2332 |
|
53 |
19 |
$3K |
| D2335 |
|
29 |
14 |
$3K |