| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,110 |
709 |
$129K |
| D1120 |
Prophylaxis - child |
3,452 |
2,997 |
$115K |
| D0120 |
Periodic oral evaluation - established patient |
4,815 |
4,227 |
$113K |
| D1110 |
Prophylaxis - adult |
1,852 |
1,698 |
$97K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,262 |
468 |
$84K |
| D1206 |
Topical application of fluoride varnish |
4,271 |
3,687 |
$81K |
| D0274 |
Bitewings - four radiographic images |
1,852 |
1,677 |
$66K |
| D0140 |
Limited oral evaluation - problem focused |
1,790 |
1,668 |
$63K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
578 |
418 |
$54K |
| D0330 |
Panoramic radiographic image |
697 |
662 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
1,282 |
1,212 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
432 |
406 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
353 |
341 |
$9K |
| D0272 |
Bitewings - two radiographic images |
194 |
163 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
28 |
26 |
$4K |
| D1351 |
Sealant - per tooth |
136 |
26 |
$4K |
| D2330 |
|
18 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
163 |
91 |
$1K |
| D1999 |
|
41 |
30 |
$0.00 |