| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,043 |
1,515 |
$160K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,004 |
1,697 |
$150K |
| D1110 |
Prophylaxis - adult |
2,874 |
2,835 |
$106K |
| D0140 |
Limited oral evaluation - problem focused |
3,773 |
3,714 |
$99K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,466 |
1,035 |
$92K |
| D0120 |
Periodic oral evaluation - established patient |
2,609 |
2,578 |
$56K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
620 |
518 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
5,337 |
4,959 |
$51K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
590 |
395 |
$49K |
| D2331 |
|
763 |
566 |
$45K |
| D1120 |
Prophylaxis - child |
1,129 |
1,122 |
$40K |
| D2940 |
|
1,086 |
805 |
$40K |
| D0210 |
Intraoral - complete series of radiographic images |
624 |
619 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,465 |
1,444 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
889 |
881 |
$26K |
| D0274 |
Bitewings - four radiographic images |
926 |
906 |
$22K |
| D0330 |
Panoramic radiographic image |
542 |
533 |
$22K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
432 |
331 |
$20K |
| D2332 |
|
232 |
157 |
$15K |
| D2335 |
|
155 |
110 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,761 |
1,261 |
$10K |
| D2330 |
|
157 |
93 |
$7K |
| D2160 |
|
91 |
80 |
$6K |
| D2951 |
|
368 |
181 |
$4K |
| D2394 |
|
31 |
27 |
$4K |
| D2140 |
|
56 |
45 |
$2K |
| D1206 |
Topical application of fluoride varnish |
68 |
66 |
$1K |
| D0272 |
Bitewings - two radiographic images |
56 |
52 |
$862.70 |
| D1999 |
|
1,521 |
1,246 |
$0.00 |