| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,139 |
1,533 |
$224K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,945 |
5,908 |
$205K |
| D2394 |
|
1,528 |
759 |
$162K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,662 |
957 |
$141K |
| D0210 |
Intraoral - complete series of radiographic images |
2,002 |
1,961 |
$112K |
| D4346 |
|
814 |
811 |
$98K |
| D0140 |
Limited oral evaluation - problem focused |
3,172 |
3,057 |
$90K |
| D0220 |
Intraoral - periapical first radiographic image |
6,398 |
6,225 |
$72K |
| D0274 |
Bitewings - four radiographic images |
2,478 |
2,469 |
$72K |
| D1110 |
Prophylaxis - adult |
1,407 |
1,398 |
$62K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
856 |
401 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,432 |
4,299 |
$40K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
276 |
142 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,433 |
1,420 |
$25K |
| D1120 |
Prophylaxis - child |
432 |
427 |
$13K |
| D9110 |
|
166 |
163 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
71 |
26 |
$5K |
| D4341 |
|
31 |
12 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
54 |
53 |
$1K |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$223.11 |
| D0270 |
|
14 |
14 |
$149.65 |