| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,186 |
557 |
$89K |
| D1110 |
Prophylaxis - adult |
1,419 |
1,365 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,577 |
1,531 |
$45K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
684 |
381 |
$42K |
| D0330 |
Panoramic radiographic image |
1,184 |
1,153 |
$40K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
312 |
111 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,526 |
1,462 |
$39K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
371 |
244 |
$31K |
| D1206 |
Topical application of fluoride varnish |
1,128 |
1,095 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,200 |
1,111 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
879 |
825 |
$20K |
| D4342 |
|
592 |
206 |
$20K |
| D1120 |
Prophylaxis - child |
429 |
402 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
77 |
76 |
$4K |
| D2331 |
|
37 |
25 |
$3K |
| D4910 |
|
28 |
27 |
$2K |
| D1351 |
Sealant - per tooth |
54 |
14 |
$1K |
| D0272 |
Bitewings - two radiographic images |
64 |
58 |
$911.59 |
| D0220 |
Intraoral - periapical first radiographic image |
106 |
97 |
$902.98 |
| D0230 |
Intraoral - periapical each additional radiographic image |
19 |
17 |
$156.40 |