| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,433 |
1,388 |
$223K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,500 |
1,446 |
$200K |
| D1110 |
Prophylaxis - adult |
4,283 |
4,279 |
$179K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,845 |
3,839 |
$136K |
| D1120 |
Prophylaxis - child |
3,321 |
3,319 |
$131K |
| D0120 |
Periodic oral evaluation - established patient |
5,099 |
5,094 |
$124K |
| D0210 |
Intraoral - complete series of radiographic images |
2,042 |
2,034 |
$121K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,658 |
949 |
$121K |
| D0140 |
Limited oral evaluation - problem focused |
3,642 |
3,535 |
$114K |
| D0220 |
Intraoral - periapical first radiographic image |
6,886 |
6,735 |
$83K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,583 |
3,580 |
$79K |
| D0274 |
Bitewings - four radiographic images |
2,990 |
2,982 |
$74K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
666 |
324 |
$71K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
557 |
397 |
$64K |
| D1351 |
Sealant - per tooth |
1,762 |
252 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,730 |
4,360 |
$38K |
| D0272 |
Bitewings - two radiographic images |
943 |
941 |
$20K |
| D5110 |
|
49 |
49 |
$18K |
| D2331 |
|
220 |
114 |
$18K |
| D0270 |
|
852 |
837 |
$10K |
| D5120 |
|
14 |
14 |
$6K |
| D2332 |
|
62 |
36 |
$4K |
| D2950 |
|
19 |
18 |
$4K |
| D2394 |
|
38 |
29 |
$3K |
| D2335 |
|
38 |
24 |
$3K |
| D2330 |
|
50 |
30 |
$3K |
| D1206 |
Topical application of fluoride varnish |
65 |
64 |
$2K |
| D7220 |
|
17 |
15 |
$2K |
| D1999 |
|
955 |
837 |
$0.00 |