| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,865 |
1,258 |
$299K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,640 |
726 |
$157K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,224 |
911 |
$133K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,275 |
2,086 |
$97K |
| D4341 |
|
2,182 |
692 |
$88K |
| D0210 |
Intraoral - complete series of radiographic images |
1,305 |
1,217 |
$62K |
| D1206 |
Topical application of fluoride varnish |
2,132 |
1,976 |
$49K |
| D1110 |
Prophylaxis - adult |
736 |
695 |
$37K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
238 |
123 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
631 |
590 |
$20K |
| D1120 |
Prophylaxis - child |
718 |
655 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
471 |
455 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,597 |
1,463 |
$15K |
| D2332 |
|
131 |
61 |
$15K |
| D0274 |
Bitewings - four radiographic images |
923 |
841 |
$12K |
| D1351 |
Sealant - per tooth |
431 |
120 |
$11K |
| D4346 |
|
164 |
156 |
$10K |
| D2330 |
|
51 |
27 |
$3K |
| D0270 |
|
275 |
267 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,148 |
1,019 |
$3K |
| D2394 |
|
21 |
15 |
$2K |