| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,768 |
946 |
$103K |
| D1110 |
Prophylaxis - adult |
3,852 |
3,268 |
$102K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,667 |
4,810 |
$92K |
| D0210 |
Intraoral - complete series of radiographic images |
2,214 |
1,864 |
$92K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,883 |
745 |
$90K |
| D0140 |
Limited oral evaluation - problem focused |
3,612 |
3,139 |
$82K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,708 |
2,058 |
$82K |
| D1120 |
Prophylaxis - child |
1,957 |
1,720 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
3,540 |
3,124 |
$70K |
| D0274 |
Bitewings - four radiographic images |
2,448 |
2,142 |
$64K |
| D0220 |
Intraoral - periapical first radiographic image |
3,120 |
2,632 |
$29K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
248 |
114 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
161 |
110 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
224 |
116 |
$11K |
| D2330 |
|
210 |
92 |
$10K |
| D2331 |
|
110 |
53 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
750 |
416 |
$6K |
| D1351 |
Sealant - per tooth |
372 |
45 |
$6K |
| D2140 |
|
111 |
75 |
$5K |
| D2950 |
|
123 |
54 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
82 |
65 |
$4K |
| D2160 |
|
54 |
39 |
$3K |
| D0270 |
|
600 |
511 |
$3K |
| D2335 |
|
19 |
13 |
$2K |
| D0272 |
Bitewings - two radiographic images |
15 |
13 |
$310.92 |