| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,446 |
2,247 |
$401K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,597 |
959 |
$172K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,226 |
3,907 |
$154K |
| D1110 |
Prophylaxis - adult |
3,640 |
3,351 |
$154K |
| D1120 |
Prophylaxis - child |
3,877 |
3,658 |
$121K |
| D0140 |
Limited oral evaluation - problem focused |
3,305 |
3,048 |
$109K |
| D0220 |
Intraoral - periapical first radiographic image |
8,399 |
7,752 |
$101K |
| D0120 |
Periodic oral evaluation - established patient |
4,209 |
3,942 |
$90K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
688 |
324 |
$68K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,021 |
566 |
$67K |
| D1206 |
Topical application of fluoride varnish |
4,166 |
3,919 |
$64K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
900 |
536 |
$63K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,319 |
5,170 |
$61K |
| D0274 |
Bitewings - four radiographic images |
2,016 |
1,867 |
$48K |
| D0210 |
Intraoral - complete series of radiographic images |
993 |
908 |
$47K |
| D0272 |
Bitewings - two radiographic images |
1,678 |
1,578 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,148 |
1,118 |
$18K |
| D0330 |
Panoramic radiographic image |
679 |
587 |
$16K |
| D1351 |
Sealant - per tooth |
293 |
102 |
$9K |
| D7250 |
|
22 |
15 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
24 |
24 |
$792.00 |