| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,017 |
1,231 |
$402K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,795 |
740 |
$199K |
| D0210 |
Intraoral - complete series of radiographic images |
2,023 |
1,974 |
$128K |
| D1110 |
Prophylaxis - adult |
3,471 |
3,407 |
$126K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,401 |
3,344 |
$95K |
| D9944 |
|
381 |
375 |
$77K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
964 |
386 |
$67K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,142 |
568 |
$65K |
| D2394 |
|
728 |
225 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
2,407 |
2,362 |
$44K |
| D0274 |
Bitewings - four radiographic images |
1,925 |
1,890 |
$40K |
| D1120 |
Prophylaxis - child |
1,845 |
1,814 |
$37K |
| D1206 |
Topical application of fluoride varnish |
2,276 |
2,239 |
$35K |
| D2335 |
|
309 |
88 |
$29K |
| D4341 |
|
283 |
75 |
$27K |
| D4342 |
|
332 |
84 |
$22K |
| D1321 |
|
897 |
892 |
$15K |
| D1320 |
|
866 |
863 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
589 |
565 |
$15K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
253 |
84 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
812 |
742 |
$4K |
| D2140 |
|
57 |
13 |
$2K |
| D0272 |
Bitewings - two radiographic images |
209 |
205 |
$2K |
| D2160 |
|
25 |
14 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
60 |
57 |
$280.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
12 |
$195.00 |