| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,549 |
476 |
$88K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,424 |
445 |
$60K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
655 |
206 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,452 |
1,401 |
$49K |
| D0210 |
Intraoral - complete series of radiographic images |
1,125 |
1,094 |
$49K |
| D4341 |
|
1,262 |
324 |
$39K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
346 |
65 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,417 |
1,368 |
$25K |
| D1110 |
Prophylaxis - adult |
516 |
486 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
645 |
597 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,524 |
1,443 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
515 |
490 |
$13K |
| D1999 |
|
296 |
242 |
$4K |
| D0274 |
Bitewings - four radiographic images |
235 |
214 |
$3K |
| D2332 |
|
40 |
13 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,069 |
661 |
$2K |
| D2330 |
|
40 |
16 |
$1K |
| D2331 |
|
28 |
14 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
16 |
12 |
$300.00 |