| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
791 |
267 |
$75K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
473 |
283 |
$52K |
| D1110 |
Prophylaxis - adult |
1,037 |
1,031 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
866 |
856 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
1,313 |
1,308 |
$35K |
| D1120 |
Prophylaxis - child |
741 |
740 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,051 |
1,049 |
$20K |
| D0272 |
Bitewings - two radiographic images |
916 |
912 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
330 |
323 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
61 |
28 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
460 |
450 |
$6K |
| D0330 |
Panoramic radiographic image |
102 |
102 |
$6K |
| D0274 |
Bitewings - four radiographic images |
138 |
129 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
65 |
64 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
27 |
13 |
$2K |
| D1351 |
Sealant - per tooth |
80 |
26 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22 |
12 |
$1K |