| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,075 |
675 |
$262K |
| D2940 |
|
7,473 |
1,660 |
$196K |
| D0210 |
Intraoral - complete series of radiographic images |
788 |
770 |
$33K |
| D1110 |
Prophylaxis - adult |
689 |
674 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
792 |
772 |
$15K |
| D4355 |
|
228 |
221 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,222 |
1,202 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
750 |
741 |
$14K |
| D1120 |
Prophylaxis - child |
486 |
480 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
167 |
30 |
$9K |
| D0272 |
Bitewings - two radiographic images |
704 |
692 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
74 |
41 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
780 |
765 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
767 |
713 |
$4K |