| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,919 |
3,654 |
$499K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,776 |
2,675 |
$451K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,412 |
9,397 |
$326K |
| D0274 |
Bitewings - four radiographic images |
6,554 |
6,537 |
$191K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,177 |
1,348 |
$188K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,390 |
1,613 |
$186K |
| D0140 |
Limited oral evaluation - problem focused |
5,737 |
5,605 |
$164K |
| D0210 |
Intraoral - complete series of radiographic images |
2,877 |
2,843 |
$161K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,160 |
6,145 |
$111K |
| D1110 |
Prophylaxis - adult |
2,178 |
2,177 |
$96K |
| D4346 |
|
685 |
684 |
$83K |
| D0220 |
Intraoral - periapical first radiographic image |
7,198 |
7,008 |
$80K |
| D1120 |
Prophylaxis - child |
1,932 |
1,929 |
$61K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
415 |
207 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,394 |
1,908 |
$27K |
| D4341 |
|
143 |
51 |
$16K |
| D0330 |
Panoramic radiographic image |
266 |
260 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
409 |
409 |
$8K |
| D2335 |
|
22 |
16 |
$3K |
| D1206 |
Topical application of fluoride varnish |
56 |
56 |
$1K |