| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
409 |
219 |
$33K |
| D0274 |
Bitewings - four radiographic images |
804 |
766 |
$24K |
| D1110 |
Prophylaxis - adult |
776 |
735 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,212 |
1,160 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
360 |
169 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
887 |
849 |
$20K |
| D1120 |
Prophylaxis - child |
428 |
414 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
472 |
427 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
254 |
101 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
239 |
222 |
$11K |
| D1351 |
Sealant - per tooth |
282 |
72 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
861 |
819 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
835 |
638 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
250 |
236 |
$6K |
| D2332 |
|
52 |
31 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
70 |
47 |
$4K |
| D2335 |
|
26 |
18 |
$3K |
| D2330 |
|
65 |
32 |
$3K |
| D2140 |
|
70 |
46 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
43 |
25 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
25 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
46 |
45 |
$1K |
| D1206 |
Topical application of fluoride varnish |
15 |
14 |
$251.14 |