| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,162 |
643 |
$62K |
| D0210 |
Intraoral - complete series of radiographic images |
1,016 |
1,000 |
$60K |
| D1110 |
Prophylaxis - adult |
1,363 |
1,351 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,438 |
1,421 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
677 |
404 |
$34K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
352 |
228 |
$22K |
| D0274 |
Bitewings - four radiographic images |
1,114 |
1,101 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
1,222 |
1,204 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
356 |
106 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
824 |
790 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
993 |
978 |
$15K |
| D1120 |
Prophylaxis - child |
594 |
581 |
$11K |
| D2394 |
|
136 |
97 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
143 |
76 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
775 |
761 |
$4K |
| D2140 |
|
68 |
46 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
433 |
379 |
$2K |
| D2331 |
|
32 |
27 |
$2K |
| D2161 |
|
24 |
15 |
$2K |
| D1351 |
Sealant - per tooth |
63 |
16 |
$1K |
| D0272 |
Bitewings - two radiographic images |
54 |
53 |
$520.00 |