| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,123 |
2,506 |
$376K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,330 |
1,716 |
$288K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,954 |
2,383 |
$273K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,471 |
6,440 |
$225K |
| D0274 |
Bitewings - four radiographic images |
6,615 |
6,577 |
$196K |
| D1110 |
Prophylaxis - adult |
4,115 |
4,104 |
$188K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,003 |
1,173 |
$176K |
| D2335 |
|
1,118 |
574 |
$144K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,721 |
6,688 |
$122K |
| D0220 |
Intraoral - periapical first radiographic image |
9,650 |
9,300 |
$110K |
| D4346 |
|
825 |
816 |
$100K |
| D0140 |
Limited oral evaluation - problem focused |
2,933 |
2,869 |
$83K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,448 |
7,287 |
$68K |
| D2332 |
|
467 |
300 |
$48K |
| D1120 |
Prophylaxis - child |
1,502 |
1,494 |
$48K |
| D2330 |
|
503 |
288 |
$34K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
219 |
164 |
$25K |
| D5214 |
|
27 |
27 |
$21K |
| D0330 |
Panoramic radiographic image |
402 |
401 |
$20K |
| D7250 |
|
135 |
53 |
$17K |
| D5110 |
|
15 |
15 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
447 |
447 |
$10K |
| D5120 |
|
12 |
12 |
$10K |
| D2394 |
|
57 |
36 |
$6K |
| D2931 |
|
15 |
13 |
$2K |