| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,304 |
3,045 |
$393K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,647 |
1,297 |
$167K |
| D1110 |
Prophylaxis - adult |
4,753 |
4,516 |
$158K |
| D0210 |
Intraoral - complete series of radiographic images |
2,966 |
2,761 |
$158K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,997 |
4,717 |
$127K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,316 |
1,081 |
$111K |
| D0120 |
Periodic oral evaluation - established patient |
6,404 |
6,093 |
$110K |
| D0274 |
Bitewings - four radiographic images |
5,407 |
5,140 |
$102K |
| D2335 |
|
763 |
190 |
$67K |
| D7140 |
Extraction, erupted tooth or exposed root |
425 |
175 |
$28K |
| D0330 |
Panoramic radiographic image |
661 |
630 |
$26K |
| D2332 |
|
298 |
77 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
979 |
941 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,443 |
1,384 |
$21K |
| D1120 |
Prophylaxis - child |
938 |
913 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
3,199 |
2,923 |
$15K |
| D2394 |
|
194 |
96 |
$14K |
| D1351 |
Sealant - per tooth |
351 |
79 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,059 |
372 |
$5K |
| D4341 |
|
36 |
12 |
$3K |
| D0272 |
Bitewings - two radiographic images |
73 |
71 |
$630.00 |
| D4910 |
|
12 |
12 |
$307.17 |