| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,357 |
1,548 |
$233K |
| D1110 |
Prophylaxis - adult |
4,836 |
4,379 |
$171K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,352 |
878 |
$161K |
| D2394 |
|
748 |
491 |
$113K |
| D0140 |
Limited oral evaluation - problem focused |
3,414 |
3,012 |
$113K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,483 |
887 |
$104K |
| D0120 |
Periodic oral evaluation - established patient |
4,436 |
4,046 |
$102K |
| D0210 |
Intraoral - complete series of radiographic images |
1,285 |
1,160 |
$84K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
722 |
339 |
$78K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,884 |
1,726 |
$76K |
| D0330 |
Panoramic radiographic image |
1,187 |
1,062 |
$60K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,076 |
2,857 |
$49K |
| D0274 |
Bitewings - four radiographic images |
1,552 |
1,369 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
3,193 |
2,814 |
$44K |
| D1120 |
Prophylaxis - child |
1,298 |
1,235 |
$35K |
| D2335 |
|
216 |
122 |
$26K |
| D2332 |
|
277 |
186 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
278 |
131 |
$18K |
| D2331 |
|
159 |
105 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
899 |
529 |
$11K |
| D0272 |
Bitewings - two radiographic images |
208 |
190 |
$4K |
| D0170 |
|
76 |
67 |
$2K |
| D4355 |
|
26 |
26 |
$2K |
| D7311 |
|
18 |
13 |
$2K |