| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,617 |
1,223 |
$200K |
| D1110 |
Prophylaxis - adult |
3,244 |
3,236 |
$164K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,443 |
886 |
$133K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,366 |
792 |
$131K |
| D0120 |
Periodic oral evaluation - established patient |
3,475 |
3,461 |
$91K |
| D2335 |
|
533 |
303 |
$66K |
| D2332 |
|
645 |
375 |
$62K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,216 |
677 |
$62K |
| D2394 |
|
504 |
371 |
$62K |
| D0274 |
Bitewings - four radiographic images |
2,149 |
2,143 |
$53K |
| D0330 |
Panoramic radiographic image |
1,628 |
1,624 |
$52K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
509 |
356 |
$42K |
| D1120 |
Prophylaxis - child |
259 |
259 |
$11K |
| D7240 |
Removal of impacted tooth - completely bony |
32 |
12 |
$9K |
| D5110 |
|
12 |
12 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
611 |
601 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
395 |
392 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
565 |
461 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
223 |
223 |
$3K |
| D2330 |
|
55 |
33 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
75 |
75 |
$2K |
| D0272 |
Bitewings - two radiographic images |
80 |
80 |
$1K |