| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,504 |
1,164 |
$158K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,013 |
472 |
$143K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,314 |
775 |
$97K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,467 |
759 |
$89K |
| D0210 |
Intraoral - complete series of radiographic images |
1,061 |
1,058 |
$73K |
| D1110 |
Prophylaxis - adult |
1,486 |
1,480 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
1,940 |
1,934 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,186 |
1,184 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,496 |
1,492 |
$35K |
| D2335 |
|
289 |
143 |
$31K |
| D2394 |
|
352 |
218 |
$28K |
| D2332 |
|
253 |
153 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,375 |
1,735 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
2,004 |
1,993 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
171 |
77 |
$9K |
| D2160 |
|
128 |
59 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
432 |
432 |
$7K |
| D0330 |
Panoramic radiographic image |
98 |
98 |
$7K |
| D2161 |
|
53 |
32 |
$4K |
| D2140 |
|
103 |
59 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
116 |
116 |
$3K |
| D4342 |
|
36 |
12 |
$2K |
| D2330 |
|
42 |
28 |
$2K |
| D1120 |
Prophylaxis - child |
13 |
12 |
$240.00 |
| D0270 |
|
12 |
12 |
$60.00 |