| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,137 |
1,123 |
$133K |
| D1110 |
Prophylaxis - adult |
2,794 |
2,648 |
$106K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,495 |
536 |
$93K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,425 |
787 |
$79K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,173 |
2,042 |
$65K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
814 |
465 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
3,089 |
2,916 |
$57K |
| D0330 |
Panoramic radiographic image |
1,024 |
949 |
$48K |
| D0140 |
Limited oral evaluation - problem focused |
1,597 |
1,477 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,372 |
2,247 |
$38K |
| D1120 |
Prophylaxis - child |
1,766 |
1,678 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,409 |
1,324 |
$32K |
| D2335 |
|
160 |
78 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
2,356 |
2,194 |
$14K |
| D0272 |
Bitewings - two radiographic images |
1,094 |
1,034 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,490 |
816 |
$9K |
| D2332 |
|
100 |
58 |
$8K |
| D2330 |
|
108 |
55 |
$5K |
| D2394 |
|
18 |
12 |
$3K |
| D2331 |
|
42 |
25 |
$2K |
| D2931 |
|
13 |
12 |
$2K |
| D1351 |
Sealant - per tooth |
56 |
15 |
$1K |
| D2140 |
|
19 |
12 |
$798.00 |