| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,348 |
632 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
2,830 |
2,745 |
$15K |
| D1120 |
Prophylaxis - child |
1,661 |
1,617 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
4,803 |
4,504 |
$13K |
| D1110 |
Prophylaxis - adult |
1,515 |
1,457 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
1,630 |
1,430 |
$11K |
| D0274 |
Bitewings - four radiographic images |
2,223 |
2,140 |
$11K |
| D1206 |
Topical application of fluoride varnish |
2,146 |
2,111 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
890 |
446 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,780 |
3,123 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
176 |
96 |
$3K |
| D2950 |
|
132 |
76 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
522 |
489 |
$2K |
| D1351 |
Sealant - per tooth |
455 |
116 |
$2K |
| D0272 |
Bitewings - two radiographic images |
495 |
485 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
445 |
415 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
51 |
28 |
$870.00 |
| D0210 |
Intraoral - complete series of radiographic images |
140 |
123 |
$601.00 |