| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,416 |
2,888 |
$485K |
| D1110 |
Prophylaxis - adult |
9,567 |
9,566 |
$472K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,668 |
2,295 |
$375K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,308 |
7,307 |
$284K |
| D0274 |
Bitewings - four radiographic images |
10,541 |
10,540 |
$282K |
| D1120 |
Prophylaxis - child |
7,531 |
7,531 |
$263K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,851 |
1,313 |
$250K |
| D0220 |
Intraoral - periapical first radiographic image |
19,526 |
19,303 |
$244K |
| D0120 |
Periodic oral evaluation - established patient |
9,793 |
9,793 |
$220K |
| D0140 |
Limited oral evaluation - problem focused |
5,457 |
5,435 |
$204K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,530 |
10,530 |
$172K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,307 |
1,288 |
$163K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,311 |
15,075 |
$156K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
952 |
656 |
$101K |
| D1351 |
Sealant - per tooth |
3,366 |
864 |
$100K |
| D0272 |
Bitewings - two radiographic images |
3,301 |
3,301 |
$62K |
| D2394 |
|
117 |
72 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
200 |
200 |
$10K |
| D0145 |
Oral evaluation for a patient under three years of age |
141 |
141 |
$6K |
| D2331 |
|
79 |
39 |
$5K |