| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,429 |
1,521 |
$181K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,033 |
1,094 |
$129K |
| D1110 |
Prophylaxis - adult |
3,618 |
3,515 |
$127K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,712 |
684 |
$102K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,839 |
2,754 |
$78K |
| D0120 |
Periodic oral evaluation - established patient |
4,354 |
4,247 |
$77K |
| D0274 |
Bitewings - four radiographic images |
4,016 |
3,913 |
$75K |
| D0330 |
Panoramic radiographic image |
1,201 |
1,159 |
$59K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,006 |
499 |
$49K |
| D0210 |
Intraoral - complete series of radiographic images |
1,798 |
982 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,807 |
2,727 |
$43K |
| D1120 |
Prophylaxis - child |
1,880 |
1,827 |
$38K |
| D0240 |
|
3,461 |
1,494 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,968 |
4,145 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
4,477 |
4,359 |
$23K |
| D2394 |
|
214 |
137 |
$15K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
187 |
87 |
$10K |
| D0272 |
Bitewings - two radiographic images |
1,036 |
1,009 |
$10K |
| D2332 |
|
114 |
68 |
$8K |
| D2160 |
|
102 |
64 |
$7K |
| D2335 |
|
65 |
36 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
127 |
126 |
$3K |