| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,131 |
544 |
$144K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
717 |
383 |
$125K |
| D0140 |
Limited oral evaluation - problem focused |
1,755 |
1,661 |
$54K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
774 |
334 |
$49K |
| D2394 |
|
212 |
119 |
$40K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
306 |
97 |
$38K |
| D1354 |
|
434 |
66 |
$33K |
| D1320 |
|
782 |
758 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,245 |
1,224 |
$26K |
| D1110 |
Prophylaxis - adult |
525 |
509 |
$25K |
| D0274 |
Bitewings - four radiographic images |
740 |
736 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,360 |
1,322 |
$22K |
| D1206 |
Topical application of fluoride varnish |
1,001 |
973 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
492 |
456 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
167 |
64 |
$11K |
| D1351 |
Sealant - per tooth |
298 |
68 |
$7K |
| D2332 |
|
58 |
26 |
$7K |
| D1120 |
Prophylaxis - child |
176 |
176 |
$5K |
| D2335 |
|
18 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
102 |
102 |
$2K |
| D0603 |
|
164 |
164 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
20 |
20 |
$438.50 |
| D0602 |
|
34 |
34 |
$311.10 |