| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,699 |
1,876 |
$324K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,120 |
1,108 |
$212K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,309 |
2,958 |
$120K |
| D0210 |
Intraoral - complete series of radiographic images |
3,046 |
2,723 |
$120K |
| D1110 |
Prophylaxis - adult |
2,080 |
1,874 |
$100K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,234 |
587 |
$61K |
| D0140 |
Limited oral evaluation - problem focused |
1,753 |
1,580 |
$51K |
| D1206 |
Topical application of fluoride varnish |
2,253 |
2,019 |
$45K |
| D4341 |
|
892 |
344 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
3,262 |
2,794 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
730 |
646 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
479 |
141 |
$18K |
| D0274 |
Bitewings - four radiographic images |
1,013 |
926 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
142 |
66 |
$13K |
| D2394 |
|
93 |
58 |
$10K |
| D1999 |
|
1,357 |
955 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,132 |
1,466 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
466 |
419 |
$5K |
| D2331 |
|
42 |
24 |
$4K |
| D1351 |
Sealant - per tooth |
214 |
39 |
$3K |
| D2330 |
|
32 |
14 |
$1K |
| D1120 |
Prophylaxis - child |
12 |
12 |
$275.76 |