| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,424 |
1,172 |
$121K |
| D0210 |
Intraoral - complete series of radiographic images |
1,970 |
1,854 |
$83K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,685 |
835 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,530 |
2,391 |
$52K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
520 |
244 |
$50K |
| D1110 |
Prophylaxis - adult |
1,252 |
1,189 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,744 |
1,648 |
$26K |
| D0330 |
Panoramic radiographic image |
482 |
458 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,445 |
1,389 |
$21K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
387 |
226 |
$21K |
| D1351 |
Sealant - per tooth |
913 |
177 |
$20K |
| D0274 |
Bitewings - four radiographic images |
1,203 |
1,150 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
886 |
841 |
$19K |
| D1120 |
Prophylaxis - child |
649 |
632 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,576 |
1,497 |
$15K |
| D4355 |
|
71 |
71 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
636 |
571 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
95 |
53 |
$4K |
| D2331 |
|
41 |
26 |
$2K |
| D0272 |
Bitewings - two radiographic images |
95 |
95 |
$1K |