| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,747 |
1,917 |
$201K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,886 |
1,271 |
$125K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,803 |
1,800 |
$110K |
| D0120 |
Periodic oral evaluation - established patient |
2,048 |
2,045 |
$108K |
| D1120 |
Prophylaxis - child |
2,327 |
2,323 |
$85K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,781 |
4,111 |
$79K |
| D0350 |
|
6,189 |
2,706 |
$58K |
| D9430 |
|
1,397 |
1,363 |
$44K |
| D0210 |
Intraoral - complete series of radiographic images |
830 |
827 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,227 |
2,224 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,866 |
1,828 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,573 |
1,572 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
226 |
142 |
$12K |
| D0274 |
Bitewings - four radiographic images |
569 |
568 |
$12K |
| D1110 |
Prophylaxis - adult |
92 |
91 |
$7K |
| D4341 |
|
115 |
29 |
$7K |
| D4910 |
|
66 |
66 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$1K |