| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,613 |
1,068 |
$76K |
| D4341 |
|
393 |
165 |
$69K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,475 |
584 |
$65K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
801 |
471 |
$41K |
| D0140 |
Limited oral evaluation - problem focused |
2,074 |
2,008 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
2,347 |
2,302 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,461 |
3,397 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,277 |
1,265 |
$32K |
| D1120 |
Prophylaxis - child |
1,376 |
1,352 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
4,240 |
4,113 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,299 |
2,756 |
$26K |
| D1110 |
Prophylaxis - adult |
1,048 |
1,028 |
$24K |
| D0274 |
Bitewings - four radiographic images |
1,412 |
1,385 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
316 |
270 |
$21K |
| D1351 |
Sealant - per tooth |
768 |
316 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
559 |
558 |
$12K |
| D0272 |
Bitewings - two radiographic images |
475 |
468 |
$6K |
| D4910 |
|
357 |
350 |
$5K |
| D0270 |
|
347 |
347 |
$1K |
| D0191 |
|
13 |
13 |
$702.24 |
| D0601 |
|
361 |
358 |
$439.00 |
| D0602 |
|
197 |
196 |
$297.00 |
| D0603 |
|
72 |
72 |
$154.00 |
| D1330 |
|
349 |
348 |
$140.00 |
| D1999 |
|
15 |
13 |
$91.00 |
| D9986 |
|
485 |
463 |
$0.00 |
| D1310 |
|
348 |
347 |
$0.00 |