| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,248 |
1,031 |
$135K |
| D1110 |
Prophylaxis - adult |
1,681 |
1,443 |
$46K |
| D0210 |
Intraoral - complete series of radiographic images |
1,719 |
1,404 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,005 |
796 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,827 |
1,491 |
$16K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
333 |
147 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
882 |
692 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
1,038 |
888 |
$7K |
| D1330 |
|
1,859 |
1,594 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
87 |
46 |
$3K |
| D0274 |
Bitewings - four radiographic images |
1,055 |
898 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,517 |
1,252 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,704 |
1,452 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
1,983 |
1,640 |
$1K |
| D4355 |
|
30 |
29 |
$696.80 |