| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,245 |
2,351 |
$403K |
| D1110 |
Prophylaxis - adult |
8,035 |
8,035 |
$402K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,960 |
1,739 |
$343K |
| D0274 |
Bitewings - four radiographic images |
8,299 |
8,299 |
$225K |
| D0120 |
Periodic oral evaluation - established patient |
9,790 |
9,790 |
$221K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,570 |
1,105 |
$216K |
| D1120 |
Prophylaxis - child |
5,953 |
5,953 |
$208K |
| D0220 |
Intraoral - periapical first radiographic image |
15,499 |
15,359 |
$197K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,271 |
1,341 |
$194K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,702 |
4,702 |
$186K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,792 |
10,792 |
$177K |
| D1351 |
Sealant - per tooth |
5,472 |
1,615 |
$164K |
| D2394 |
|
1,133 |
666 |
$156K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,698 |
12,717 |
$136K |
| D0140 |
Limited oral evaluation - problem focused |
3,298 |
3,290 |
$125K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
965 |
572 |
$71K |
| D0272 |
Bitewings - two radiographic images |
2,884 |
2,884 |
$55K |
| D2335 |
|
38 |
26 |
$4K |
| D2332 |
|
37 |
26 |
$4K |
| D2161 |
|
27 |
13 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$468.00 |
| D0270 |
|
13 |
13 |
$158.86 |