| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,248 |
1,188 |
$204K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,092 |
554 |
$92K |
| D9110 |
|
1,988 |
1,756 |
$47K |
| D0210 |
Intraoral - complete series of radiographic images |
1,098 |
1,067 |
$46K |
| D2335 |
|
432 |
206 |
$29K |
| D1110 |
Prophylaxis - adult |
1,029 |
1,004 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
1,377 |
1,313 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,190 |
1,155 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,488 |
1,450 |
$18K |
| D0272 |
Bitewings - two radiographic images |
894 |
867 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,396 |
1,268 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
178 |
114 |
$9K |
| D1120 |
Prophylaxis - child |
413 |
399 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,046 |
886 |
$6K |