| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,185 |
730 |
$73K |
| D7140 |
Extraction, erupted tooth or exposed root |
871 |
310 |
$68K |
| D1110 |
Prophylaxis - adult |
1,845 |
1,830 |
$63K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
966 |
652 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
2,090 |
2,075 |
$39K |
| D0210 |
Intraoral - complete series of radiographic images |
563 |
563 |
$26K |
| D1206 |
Topical application of fluoride varnish |
1,247 |
1,229 |
$23K |
| D1330 |
|
1,927 |
1,920 |
$22K |
| D1120 |
Prophylaxis - child |
690 |
683 |
$22K |
| D0330 |
Panoramic radiographic image |
651 |
638 |
$22K |
| D1310 |
|
1,947 |
1,940 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,097 |
1,086 |
$21K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
279 |
198 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
936 |
912 |
$17K |
| D0274 |
Bitewings - four radiographic images |
542 |
541 |
$14K |
| D2330 |
|
285 |
194 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,390 |
1,364 |
$10K |
| D5110 |
|
17 |
17 |
$9K |
| D1351 |
Sealant - per tooth |
325 |
35 |
$8K |
| D0272 |
Bitewings - two radiographic images |
515 |
497 |
$8K |
| D5120 |
|
15 |
15 |
$8K |
| D2331 |
|
139 |
92 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
97 |
96 |
$5K |
| D9110 |
|
87 |
81 |
$2K |
| D2332 |
|
23 |
13 |
$1K |
| D1999 |
|
18 |
18 |
$77.00 |