| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,058 |
4,009 |
$732K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
11,757 |
4,024 |
$645K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,404 |
2,344 |
$489K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
11,418 |
11,347 |
$391K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,070 |
1,859 |
$338K |
| D0210 |
Intraoral - complete series of radiographic images |
5,024 |
4,920 |
$286K |
| D1110 |
Prophylaxis - adult |
4,567 |
4,536 |
$205K |
| D0274 |
Bitewings - four radiographic images |
6,200 |
6,154 |
$180K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,484 |
7,436 |
$134K |
| D0140 |
Limited oral evaluation - problem focused |
3,709 |
3,624 |
$108K |
| D0220 |
Intraoral - periapical first radiographic image |
9,045 |
8,710 |
$101K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
747 |
526 |
$65K |
| D1120 |
Prophylaxis - child |
2,012 |
2,000 |
$63K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,732 |
5,002 |
$54K |
| D4341 |
|
230 |
62 |
$28K |
| D9110 |
|
432 |
428 |
$24K |
| D4346 |
|
109 |
109 |
$13K |
| D2330 |
|
166 |
91 |
$11K |
| D7240 |
Removal of impacted tooth - completely bony |
52 |
24 |
$9K |
| D2331 |
|
71 |
49 |
$6K |
| D2335 |
|
47 |
27 |
$6K |
| D7250 |
|
32 |
15 |
$4K |
| D0330 |
Panoramic radiographic image |
41 |
41 |
$2K |
| D1206 |
Topical application of fluoride varnish |
59 |
59 |
$993.43 |