| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,328 |
714 |
$90K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,759 |
1,718 |
$58K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
836 |
459 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,293 |
1,258 |
$36K |
| D1110 |
Prophylaxis - adult |
794 |
765 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
544 |
523 |
$28K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
310 |
209 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
2,141 |
2,082 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,285 |
1,246 |
$22K |
| D1120 |
Prophylaxis - child |
474 |
460 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,601 |
1,518 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
394 |
383 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
44 |
34 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
143 |
131 |
$3K |
| D2394 |
|
16 |
14 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
24 |
15 |
$1K |