| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
767 |
432 |
$41K |
| D0210 |
Intraoral - complete series of radiographic images |
676 |
619 |
$36K |
| D1110 |
Prophylaxis - adult |
1,019 |
971 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
560 |
358 |
$28K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
370 |
237 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
835 |
777 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
1,072 |
1,025 |
$18K |
| D1351 |
Sealant - per tooth |
741 |
214 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
268 |
109 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
941 |
895 |
$14K |
| D1120 |
Prophylaxis - child |
595 |
562 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
359 |
337 |
$8K |
| D0274 |
Bitewings - four radiographic images |
364 |
347 |
$7K |
| D2394 |
|
96 |
64 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
612 |
537 |
$3K |
| D2335 |
|
20 |
12 |
$2K |
| D0330 |
Panoramic radiographic image |
24 |
19 |
$1K |
| D0272 |
Bitewings - two radiographic images |
102 |
99 |
$996.50 |
| D0230 |
Intraoral - periapical each additional radiographic image |
45 |
24 |
$256.50 |
| D0270 |
|
31 |
28 |
$135.25 |