| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,045 |
2,208 |
$190K |
| D9110 |
|
2,676 |
2,310 |
$141K |
| D1120 |
Prophylaxis - child |
2,637 |
2,467 |
$103K |
| D4341 |
|
636 |
384 |
$93K |
| D0120 |
Periodic oral evaluation - established patient |
3,390 |
3,190 |
$91K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,152 |
919 |
$73K |
| D1110 |
Prophylaxis - adult |
1,850 |
1,746 |
$69K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,576 |
2,422 |
$63K |
| D0140 |
Limited oral evaluation - problem focused |
3,034 |
2,616 |
$47K |
| D2750 |
|
157 |
127 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,799 |
1,697 |
$36K |
| D1351 |
Sealant - per tooth |
594 |
304 |
$36K |
| D0274 |
Bitewings - four radiographic images |
2,299 |
2,132 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
798 |
628 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
5,012 |
4,483 |
$28K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
380 |
298 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,720 |
3,296 |
$23K |
| D2332 |
|
149 |
126 |
$11K |
| D2950 |
|
146 |
123 |
$9K |
| D2331 |
|
117 |
98 |
$7K |
| D0330 |
Panoramic radiographic image |
175 |
173 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
54 |
42 |
$2K |
| D0272 |
Bitewings - two radiographic images |
202 |
194 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
146 |
138 |
$620.80 |