| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,010 |
1,689 |
$217K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,061 |
3,057 |
$105K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,471 |
875 |
$79K |
| D0274 |
Bitewings - four radiographic images |
2,673 |
2,671 |
$77K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
866 |
621 |
$74K |
| D1110 |
Prophylaxis - adult |
1,493 |
1,490 |
$66K |
| D0210 |
Intraoral - complete series of radiographic images |
1,088 |
1,078 |
$60K |
| D1120 |
Prophylaxis - child |
1,644 |
1,642 |
$50K |
| D7140 |
Extraction, erupted tooth or exposed root |
747 |
336 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
4,327 |
4,269 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,621 |
2,618 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
1,328 |
1,296 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,266 |
3,158 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
794 |
794 |
$17K |
| D4341 |
|
63 |
28 |
$7K |
| D2394 |
|
34 |
26 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
13 |
12 |
$2K |
| D0270 |
|
25 |
25 |
$271.84 |