| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,921 |
1,161 |
$111K |
| D1110 |
Prophylaxis - adult |
1,597 |
1,559 |
$61K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,802 |
1,735 |
$53K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,153 |
705 |
$52K |
| D0120 |
Periodic oral evaluation - established patient |
1,709 |
1,692 |
$38K |
| D1206 |
Topical application of fluoride varnish |
2,531 |
2,491 |
$35K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
318 |
116 |
$33K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
410 |
323 |
$27K |
| D1120 |
Prophylaxis - child |
1,232 |
1,211 |
$27K |
| D0330 |
Panoramic radiographic image |
624 |
595 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
2,637 |
2,551 |
$20K |
| D0274 |
Bitewings - four radiographic images |
1,475 |
1,433 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
664 |
643 |
$14K |
| D1351 |
Sealant - per tooth |
658 |
212 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
298 |
277 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,409 |
1,968 |
$11K |
| D0272 |
Bitewings - two radiographic images |
823 |
817 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
160 |
92 |
$7K |
| D2332 |
|
77 |
49 |
$5K |
| D4341 |
|
110 |
43 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
164 |
153 |
$3K |
| D0240 |
|
110 |
52 |
$810.81 |
| D9999 |
Unspecified adjunctive procedure, by report |
19 |
19 |
$468.86 |