| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
966 |
636 |
$50K |
| D4355 |
|
584 |
545 |
$37K |
| D0274 |
Bitewings - four radiographic images |
2,053 |
1,625 |
$28K |
| D1110 |
Prophylaxis - adult |
1,001 |
897 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
605 |
570 |
$23K |
| D1351 |
Sealant - per tooth |
1,473 |
394 |
$22K |
| D0330 |
Panoramic radiographic image |
591 |
545 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,721 |
1,615 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,031 |
948 |
$20K |
| D1120 |
Prophylaxis - child |
828 |
776 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
277 |
218 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
1,229 |
1,113 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
398 |
299 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
321 |
200 |
$12K |
| D9110 |
|
500 |
464 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,192 |
1,048 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
463 |
434 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
885 |
598 |
$4K |
| D0240 |
|
126 |
82 |
$1K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
14 |
12 |
$1K |
| D0350 |
|
29 |
25 |
$424.96 |