| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
954 |
555 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,672 |
1,626 |
$55K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
661 |
181 |
$55K |
| D0274 |
Bitewings - four radiographic images |
1,939 |
1,900 |
$54K |
| D1120 |
Prophylaxis - child |
1,826 |
1,785 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,413 |
2,361 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
763 |
377 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
2,150 |
2,060 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
1,076 |
1,062 |
$22K |
| D9243 |
|
357 |
91 |
$20K |
| D0330 |
Panoramic radiographic image |
416 |
403 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
605 |
558 |
$16K |
| D1110 |
Prophylaxis - adult |
387 |
384 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,675 |
1,614 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
247 |
237 |
$13K |
| D1351 |
Sealant - per tooth |
540 |
156 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
189 |
66 |
$12K |
| D4346 |
|
67 |
65 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
49 |
31 |
$4K |
| D4341 |
|
26 |
12 |
$3K |
| D9239 |
|
57 |
52 |
$3K |
| D9610 |
|
82 |
75 |
$2K |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$217.17 |