| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,460 |
1,235 |
$241K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,892 |
1,229 |
$120K |
| D1110 |
Prophylaxis - adult |
2,091 |
2,088 |
$80K |
| D0274 |
Bitewings - four radiographic images |
3,369 |
3,360 |
$78K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,654 |
2,646 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
2,781 |
2,778 |
$59K |
| D0220 |
Intraoral - periapical first radiographic image |
5,750 |
5,614 |
$58K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
832 |
526 |
$57K |
| D0140 |
Limited oral evaluation - problem focused |
1,937 |
1,885 |
$47K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,883 |
4,544 |
$40K |
| D4355 |
|
672 |
670 |
$37K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
588 |
481 |
$30K |
| D1120 |
Prophylaxis - child |
659 |
658 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
789 |
788 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
341 |
341 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
78 |
55 |
$5K |
| D2394 |
|
35 |
28 |
$3K |
| D1351 |
Sealant - per tooth |
93 |
12 |
$3K |
| D0272 |
Bitewings - two radiographic images |
88 |
88 |
$2K |
| D1999 |
|
12 |
12 |
$0.00 |