| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,978 |
670 |
$107K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,282 |
584 |
$86K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
842 |
840 |
$55K |
| D1110 |
Prophylaxis - adult |
509 |
508 |
$45K |
| D2330 |
|
544 |
253 |
$43K |
| D0210 |
Intraoral - complete series of radiographic images |
523 |
523 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
288 |
189 |
$23K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
181 |
115 |
$21K |
| D1206 |
Topical application of fluoride varnish |
740 |
739 |
$13K |
| D1120 |
Prophylaxis - child |
229 |
229 |
$12K |
| D9430 |
|
152 |
151 |
$5K |
| D0274 |
Bitewings - four radiographic images |
191 |
189 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
466 |
280 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
115 |
115 |
$1K |