| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,707 |
1,642 |
$230K |
| D1110 |
Prophylaxis - adult |
5,751 |
5,720 |
$174K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,160 |
1,147 |
$158K |
| D0210 |
Intraoral - complete series of radiographic images |
3,512 |
3,444 |
$132K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,820 |
5,773 |
$129K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,666 |
1,454 |
$115K |
| D0120 |
Periodic oral evaluation - established patient |
4,455 |
4,430 |
$88K |
| D0274 |
Bitewings - four radiographic images |
4,835 |
4,808 |
$81K |
| D0140 |
Limited oral evaluation - problem focused |
3,830 |
3,644 |
$73K |
| D1120 |
Prophylaxis - child |
1,815 |
1,809 |
$70K |
| D0330 |
Panoramic radiographic image |
2,830 |
2,813 |
$59K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,336 |
604 |
$53K |
| D0220 |
Intraoral - periapical first radiographic image |
7,028 |
6,875 |
$46K |
| D4355 |
|
917 |
914 |
$43K |
| D1206 |
Topical application of fluoride varnish |
1,532 |
1,525 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,195 |
5,718 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
499 |
222 |
$20K |
| D7250 |
|
284 |
175 |
$11K |
| D5110 |
|
14 |
13 |
$4K |
| D9110 |
|
188 |
187 |
$3K |
| D2950 |
|
37 |
26 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
15 |
15 |
$350.00 |
| D9986 |
|
37 |
34 |
$0.00 |