| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,890 |
1,089 |
$92K |
| D1110 |
Prophylaxis - adult |
2,412 |
2,391 |
$70K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,809 |
701 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
2,685 |
2,665 |
$48K |
| D0274 |
Bitewings - four radiographic images |
2,257 |
2,240 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
2,061 |
2,003 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,807 |
1,796 |
$38K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
458 |
335 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
987 |
946 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
4,117 |
3,973 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
803 |
494 |
$25K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
417 |
267 |
$22K |
| D0330 |
Panoramic radiographic image |
760 |
755 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,745 |
2,764 |
$18K |
| D4355 |
|
83 |
83 |
$3K |
| D2331 |
|
18 |
12 |
$1K |
| D1120 |
Prophylaxis - child |
29 |
29 |
$961.00 |
| D1351 |
Sealant - per tooth |
87 |
15 |
$929.00 |
| D0270 |
|
92 |
90 |
$650.97 |
| D1206 |
Topical application of fluoride varnish |
24 |
24 |
$400.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
15 |
14 |
$180.00 |
| D0460 |
|
19 |
19 |
$0.00 |