| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,387 |
862 |
$205K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,327 |
767 |
$144K |
| D1110 |
Prophylaxis - adult |
1,840 |
1,766 |
$117K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
693 |
326 |
$111K |
| D2950 |
|
441 |
301 |
$78K |
| D0120 |
Periodic oral evaluation - established patient |
2,132 |
2,052 |
$71K |
| D0140 |
Limited oral evaluation - problem focused |
1,191 |
1,092 |
$60K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
358 |
186 |
$56K |
| D0210 |
Intraoral - complete series of radiographic images |
591 |
561 |
$55K |
| D1206 |
Topical application of fluoride varnish |
1,669 |
1,596 |
$46K |
| D4341 |
|
320 |
111 |
$42K |
| D0274 |
Bitewings - four radiographic images |
771 |
741 |
$32K |
| D1120 |
Prophylaxis - child |
467 |
444 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
251 |
239 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
808 |
728 |
$17K |
| D2331 |
|
59 |
37 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
41 |
24 |
$5K |
| D2330 |
|
33 |
15 |
$3K |
| D0330 |
Panoramic radiographic image |
33 |
31 |
$2K |
| D4910 |
|
14 |
14 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
27 |
26 |
$450.00 |