| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,396 |
594 |
$93K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
744 |
333 |
$86K |
| D1110 |
Prophylaxis - adult |
1,006 |
999 |
$78K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,262 |
484 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,002 |
998 |
$59K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
615 |
283 |
$41K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
507 |
250 |
$40K |
| D0210 |
Intraoral - complete series of radiographic images |
843 |
839 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
848 |
843 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,280 |
1,613 |
$26K |
| D2140 |
|
377 |
177 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,732 |
1,722 |
$20K |
| D1120 |
Prophylaxis - child |
642 |
639 |
$19K |
| D2160 |
|
148 |
88 |
$12K |
| D9430 |
|
358 |
344 |
$11K |
| D0272 |
Bitewings - two radiographic images |
906 |
898 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
658 |
625 |
$8K |
| D0350 |
|
679 |
187 |
$7K |
| D4341 |
|
95 |
31 |
$6K |
| D4910 |
|
71 |
71 |
$5K |
| D2330 |
|
24 |
13 |
$2K |
| D1351 |
Sealant - per tooth |
53 |
12 |
$1K |