| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,908 |
797 |
$160K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,339 |
657 |
$156K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,541 |
1,463 |
$70K |
| D0210 |
Intraoral - complete series of radiographic images |
1,359 |
1,285 |
$67K |
| D4341 |
|
1,111 |
386 |
$50K |
| D1110 |
Prophylaxis - adult |
831 |
785 |
$48K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
581 |
285 |
$37K |
| D2335 |
|
228 |
98 |
$33K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
256 |
96 |
$29K |
| D2394 |
|
202 |
143 |
$24K |
| D2332 |
|
196 |
93 |
$24K |
| D1206 |
Topical application of fluoride varnish |
729 |
718 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
399 |
384 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
707 |
691 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
217 |
214 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
236 |
206 |
$5K |
| D0274 |
Bitewings - four radiographic images |
235 |
235 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
283 |
278 |
$733.02 |
| D1120 |
Prophylaxis - child |
19 |
19 |
$436.62 |