| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,899 |
859 |
$95K |
| D1110 |
Prophylaxis - adult |
1,819 |
1,812 |
$57K |
| D7140 |
Extraction, erupted tooth or exposed root |
916 |
332 |
$50K |
| D0140 |
Limited oral evaluation - problem focused |
1,977 |
1,905 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,456 |
1,450 |
$34K |
| D0274 |
Bitewings - four radiographic images |
1,863 |
1,848 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
1,796 |
1,787 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
772 |
692 |
$27K |
| D1206 |
Topical application of fluoride varnish |
1,828 |
1,822 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
483 |
257 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
3,883 |
3,758 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,543 |
2,757 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
206 |
88 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
191 |
133 |
$11K |
| D1120 |
Prophylaxis - child |
438 |
433 |
$8K |
| D0330 |
Panoramic radiographic image |
103 |
103 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
60 |
28 |
$3K |
| D0350 |
|
365 |
263 |
$3K |
| D0272 |
Bitewings - two radiographic images |
165 |
163 |
$2K |
| D2140 |
|
32 |
15 |
$1K |