| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,933 |
1,386 |
$160K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,572 |
4,022 |
$159K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,168 |
6,543 |
$132K |
| D1120 |
Prophylaxis - child |
3,619 |
3,053 |
$132K |
| D1110 |
Prophylaxis - adult |
4,923 |
3,814 |
$115K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,191 |
997 |
$100K |
| D0210 |
Intraoral - complete series of radiographic images |
2,675 |
2,053 |
$94K |
| D0140 |
Limited oral evaluation - problem focused |
4,278 |
3,361 |
$91K |
| D0274 |
Bitewings - four radiographic images |
3,622 |
2,961 |
$86K |
| D0120 |
Periodic oral evaluation - established patient |
3,745 |
3,183 |
$80K |
| D1351 |
Sealant - per tooth |
1,668 |
318 |
$43K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,023 |
330 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
4,008 |
3,119 |
$35K |
| D7140 |
Extraction, erupted tooth or exposed root |
801 |
243 |
$35K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
510 |
300 |
$33K |
| D0330 |
Panoramic radiographic image |
295 |
170 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,143 |
618 |
$8K |
| D0272 |
Bitewings - two radiographic images |
393 |
336 |
$8K |
| D0270 |
|
772 |
610 |
$3K |
| D7250 |
|
32 |
12 |
$3K |
| D2330 |
|
60 |
28 |
$2K |
| D2950 |
|
33 |
12 |
$773.76 |
| D1206 |
Topical application of fluoride varnish |
16 |
13 |
$192.08 |