| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,265 |
1,259 |
$189K |
| D1110 |
Prophylaxis - adult |
3,179 |
2,879 |
$165K |
| D0210 |
Intraoral - complete series of radiographic images |
1,983 |
1,673 |
$140K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,099 |
1,834 |
$84K |
| D0120 |
Periodic oral evaluation - established patient |
3,324 |
3,047 |
$82K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
784 |
526 |
$81K |
| D0140 |
Limited oral evaluation - problem focused |
1,758 |
1,539 |
$66K |
| D0274 |
Bitewings - four radiographic images |
1,512 |
1,403 |
$55K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
792 |
478 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
3,297 |
2,927 |
$44K |
| D7140 |
Extraction, erupted tooth or exposed root |
528 |
230 |
$43K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
184 |
113 |
$32K |
| D1206 |
Topical application of fluoride varnish |
1,595 |
1,476 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,645 |
1,969 |
$28K |
| D1120 |
Prophylaxis - child |
709 |
648 |
$23K |
| D4341 |
|
66 |
26 |
$10K |
| D0330 |
Panoramic radiographic image |
125 |
104 |
$6K |
| D4910 |
|
43 |
33 |
$3K |
| D2332 |
|
21 |
12 |
$3K |
| D0277 |
|
53 |
52 |
$3K |
| D4346 |
|
13 |
13 |
$2K |
| D1999 |
|
533 |
429 |
$450.00 |
| D9986 |
|
27 |
26 |
$0.00 |