| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,178 |
800 |
$94K |
| D1110 |
Prophylaxis - adult |
2,426 |
2,400 |
$84K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,471 |
519 |
$67K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
821 |
614 |
$49K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
473 |
366 |
$44K |
| D0210 |
Intraoral - complete series of radiographic images |
818 |
794 |
$39K |
| D1120 |
Prophylaxis - child |
1,001 |
1,000 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
1,766 |
1,757 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
1,338 |
1,297 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,102 |
1,097 |
$28K |
| D1206 |
Topical application of fluoride varnish |
1,055 |
1,055 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
824 |
819 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,350 |
1,319 |
$11K |
| D2331 |
|
119 |
86 |
$8K |
| D0191 |
|
200 |
199 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
53 |
24 |
$3K |
| D1351 |
Sealant - per tooth |
91 |
26 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
538 |
264 |
$3K |
| D2335 |
|
24 |
15 |
$2K |
| D2330 |
|
45 |
39 |
$2K |
| D2332 |
|
35 |
26 |
$2K |
| D4355 |
|
29 |
29 |
$1K |
| D2394 |
|
14 |
12 |
$1K |