| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
775 |
357 |
$79K |
| D0120 |
Periodic oral evaluation - established patient |
2,727 |
2,726 |
$76K |
| D0274 |
Bitewings - four radiographic images |
2,763 |
2,762 |
$70K |
| D1110 |
Prophylaxis - adult |
1,660 |
1,659 |
$60K |
| D2394 |
|
285 |
150 |
$53K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
343 |
209 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
4,458 |
4,352 |
$47K |
| D1120 |
Prophylaxis - child |
1,823 |
1,823 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
1,531 |
1,471 |
$46K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
267 |
132 |
$39K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
560 |
244 |
$38K |
| D0210 |
Intraoral - complete series of radiographic images |
585 |
585 |
$34K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
718 |
332 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,676 |
2,676 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,872 |
3,455 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
710 |
710 |
$25K |
| D1206 |
Topical application of fluoride varnish |
979 |
979 |
$23K |
| D2160 |
|
298 |
165 |
$16K |
| D4341 |
|
245 |
125 |
$15K |
| D0330 |
Panoramic radiographic image |
303 |
303 |
$14K |
| D1351 |
Sealant - per tooth |
467 |
173 |
$11K |
| D4355 |
|
121 |
121 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
85 |
57 |
$4K |
| D2332 |
|
26 |
12 |
$2K |
| D4910 |
|
15 |
15 |
$1K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$208.23 |