| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,347 |
1,410 |
$236K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,487 |
1,148 |
$202K |
| D1110 |
Prophylaxis - adult |
3,550 |
3,345 |
$126K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,294 |
566 |
$124K |
| D0120 |
Periodic oral evaluation - established patient |
4,203 |
3,938 |
$102K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,263 |
808 |
$90K |
| D0274 |
Bitewings - four radiographic images |
2,566 |
2,416 |
$75K |
| D0220 |
Intraoral - periapical first radiographic image |
4,750 |
4,446 |
$68K |
| D5110 |
|
148 |
122 |
$64K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,422 |
1,332 |
$60K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,602 |
3,567 |
$60K |
| D0140 |
Limited oral evaluation - problem focused |
1,707 |
1,591 |
$59K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
464 |
333 |
$56K |
| D0330 |
Panoramic radiographic image |
1,139 |
1,067 |
$56K |
| D7311 |
|
274 |
155 |
$22K |
| D1120 |
Prophylaxis - child |
852 |
810 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
915 |
880 |
$15K |
| D5211 |
|
49 |
38 |
$14K |
| D5212 |
|
40 |
37 |
$14K |
| D1206 |
Topical application of fluoride varnish |
632 |
590 |
$10K |
| D7310 |
|
91 |
49 |
$9K |
| D2331 |
|
72 |
37 |
$5K |
| D7250 |
|
34 |
13 |
$4K |
| D0272 |
Bitewings - two radiographic images |
189 |
181 |
$3K |
| D2332 |
|
20 |
13 |
$2K |
| D1351 |
Sealant - per tooth |
38 |
12 |
$1K |
| D4355 |
|
18 |
13 |
$906.72 |
| D2330 |
|
14 |
12 |
$883.70 |