| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,828 |
906 |
$117K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,489 |
2,349 |
$80K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
831 |
292 |
$73K |
| D0274 |
Bitewings - four radiographic images |
2,394 |
2,282 |
$65K |
| D9243 |
|
933 |
285 |
$62K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,022 |
2,864 |
$51K |
| D1120 |
Prophylaxis - child |
1,767 |
1,660 |
$51K |
| D0220 |
Intraoral - periapical first radiographic image |
3,220 |
3,036 |
$34K |
| D1110 |
Prophylaxis - adult |
763 |
733 |
$31K |
| D9239 |
|
288 |
260 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
855 |
808 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
290 |
170 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,386 |
2,166 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
762 |
727 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
276 |
145 |
$13K |
| D0330 |
Panoramic radiographic image |
270 |
259 |
$13K |
| D4346 |
|
87 |
87 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
99 |
43 |
$7K |
| D9610 |
|
279 |
255 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
97 |
87 |
$5K |
| D4341 |
|
40 |
14 |
$5K |