| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,932 |
1,901 |
$208K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,602 |
549 |
$175K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,709 |
4,628 |
$160K |
| D4346 |
|
1,330 |
1,311 |
$157K |
| D0274 |
Bitewings - four radiographic images |
4,400 |
4,327 |
$126K |
| D9243 |
|
1,295 |
664 |
$126K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,333 |
5,242 |
$95K |
| D0210 |
Intraoral - complete series of radiographic images |
1,463 |
1,438 |
$86K |
| D9239 |
|
679 |
663 |
$82K |
| D1120 |
Prophylaxis - child |
2,433 |
2,399 |
$77K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
808 |
635 |
$70K |
| D1110 |
Prophylaxis - adult |
1,646 |
1,618 |
$68K |
| D0220 |
Intraoral - periapical first radiographic image |
5,848 |
5,726 |
$65K |
| D7240 |
Removal of impacted tooth - completely bony |
313 |
104 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,622 |
4,474 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
1,235 |
1,210 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
1,163 |
1,144 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
413 |
294 |
$21K |
| D9610 |
|
610 |
592 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
198 |
79 |
$12K |
| D1351 |
Sealant - per tooth |
338 |
82 |
$9K |
| D0330 |
Panoramic radiographic image |
114 |
114 |
$5K |
| D2331 |
|
40 |
27 |
$3K |
| D2335 |
|
18 |
12 |
$2K |