| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,585 |
890 |
$104K |
| D0120 |
Periodic oral evaluation - established patient |
1,375 |
1,315 |
$32K |
| D1110 |
Prophylaxis - adult |
1,112 |
1,047 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
525 |
316 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
714 |
657 |
$25K |
| D1351 |
Sealant - per tooth |
1,355 |
373 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
530 |
246 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,536 |
1,458 |
$19K |
| D0330 |
Panoramic radiographic image |
659 |
612 |
$19K |
| D0274 |
Bitewings - four radiographic images |
539 |
508 |
$17K |
| D1120 |
Prophylaxis - child |
693 |
670 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,118 |
1,079 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
781 |
714 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
72 |
52 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
223 |
212 |
$4K |
| D2332 |
|
23 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19 |
12 |
$115.92 |
| D1999 |
|
206 |
174 |
$0.00 |