| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,979 |
1,054 |
$125K |
| D0210 |
Intraoral - complete series of radiographic images |
2,422 |
2,219 |
$124K |
| D1110 |
Prophylaxis - adult |
2,546 |
2,336 |
$106K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,163 |
520 |
$86K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,614 |
2,427 |
$85K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
523 |
211 |
$82K |
| D0140 |
Limited oral evaluation - problem focused |
1,871 |
1,696 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
2,276 |
2,088 |
$45K |
| D0274 |
Bitewings - four radiographic images |
1,526 |
1,400 |
$39K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
719 |
457 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
2,762 |
2,471 |
$30K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
281 |
198 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,555 |
1,016 |
$18K |
| D1206 |
Topical application of fluoride varnish |
1,186 |
1,079 |
$18K |
| D0330 |
Panoramic radiographic image |
452 |
409 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,040 |
950 |
$13K |
| D0270 |
|
578 |
542 |
$10K |
| D1120 |
Prophylaxis - child |
199 |
184 |
$5K |
| D1351 |
Sealant - per tooth |
170 |
29 |
$3K |
| D1999 |
|
28 |
25 |
$108.86 |
| D0431 |
|
29 |
25 |
$0.00 |