| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,385 |
1,348 |
$123K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,455 |
1,167 |
$98K |
| D1110 |
Prophylaxis - adult |
2,001 |
1,964 |
$69K |
| D0120 |
Periodic oral evaluation - established patient |
3,226 |
3,176 |
$68K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,076 |
657 |
$67K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
903 |
627 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,919 |
1,874 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,073 |
3,036 |
$40K |
| D4341 |
|
1,539 |
437 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
1,932 |
1,875 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
4,984 |
4,710 |
$34K |
| D0330 |
Panoramic radiographic image |
1,310 |
1,276 |
$33K |
| D1120 |
Prophylaxis - child |
1,334 |
1,322 |
$29K |
| D0272 |
Bitewings - two radiographic images |
2,434 |
2,398 |
$22K |
| D2335 |
|
293 |
126 |
$21K |
| D0274 |
Bitewings - four radiographic images |
1,974 |
1,929 |
$18K |
| D2332 |
|
179 |
108 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,982 |
3,177 |
$10K |
| D4910 |
|
216 |
211 |
$9K |
| D2394 |
|
144 |
115 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
149 |
73 |
$9K |
| D2330 |
|
194 |
113 |
$7K |
| D1206 |
Topical application of fluoride varnish |
285 |
280 |
$4K |
| D0270 |
|
58 |
58 |
$235.20 |