| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,126 |
1,257 |
$319K |
| D1110 |
Prophylaxis - adult |
2,777 |
2,777 |
$138K |
| D0120 |
Periodic oral evaluation - established patient |
4,938 |
4,938 |
$113K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,149 |
631 |
$95K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,209 |
5,209 |
$84K |
| D1120 |
Prophylaxis - child |
2,308 |
2,308 |
$79K |
| D0272 |
Bitewings - two radiographic images |
3,624 |
3,624 |
$67K |
| D0330 |
Panoramic radiographic image |
1,263 |
1,263 |
$61K |
| D0140 |
Limited oral evaluation - problem focused |
1,099 |
1,096 |
$40K |
| D0274 |
Bitewings - four radiographic images |
856 |
856 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
146 |
90 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
231 |
231 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
104 |
104 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
63 |
28 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
28 |
14 |
$4K |