| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,591 |
1,420 |
$176K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,544 |
2,450 |
$93K |
| D0120 |
Periodic oral evaluation - established patient |
3,268 |
3,170 |
$87K |
| D1110 |
Prophylaxis - adult |
1,961 |
1,911 |
$87K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,496 |
909 |
$81K |
| D0140 |
Limited oral evaluation - problem focused |
2,230 |
1,991 |
$70K |
| D1120 |
Prophylaxis - child |
1,618 |
1,575 |
$62K |
| D0274 |
Bitewings - four radiographic images |
2,043 |
1,964 |
$46K |
| D0210 |
Intraoral - complete series of radiographic images |
989 |
961 |
$44K |
| D4346 |
|
604 |
600 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,081 |
2,008 |
$38K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
407 |
279 |
$34K |
| D1206 |
Topical application of fluoride varnish |
1,678 |
1,626 |
$31K |
| D0603 |
|
2,489 |
2,366 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,697 |
1,590 |
$17K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
122 |
62 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
117 |
64 |
$9K |
| D2331 |
|
100 |
56 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
62 |
28 |
$4K |
| D0602 |
|
383 |
380 |
$3K |
| D2330 |
|
47 |
26 |
$2K |
| D1351 |
Sealant - per tooth |
56 |
14 |
$2K |
| D0601 |
|
273 |
260 |
$2K |
| D0272 |
Bitewings - two radiographic images |
61 |
61 |
$884.50 |
| D0230 |
Intraoral - periapical each additional radiographic image |
14 |
14 |
$98.00 |
| D0191 |
|
36 |
29 |
$94.50 |