| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,919 |
908 |
$118K |
| D1110 |
Prophylaxis - adult |
2,516 |
2,414 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
3,290 |
3,171 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,861 |
1,764 |
$58K |
| D7140 |
Extraction, erupted tooth or exposed root |
888 |
329 |
$58K |
| D0210 |
Intraoral - complete series of radiographic images |
688 |
658 |
$54K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
896 |
506 |
$51K |
| D1120 |
Prophylaxis - child |
2,284 |
2,187 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,503 |
2,413 |
$38K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
465 |
248 |
$36K |
| D0274 |
Bitewings - four radiographic images |
1,180 |
1,128 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
394 |
368 |
$11K |
| D0272 |
Bitewings - two radiographic images |
854 |
805 |
$9K |
| D1206 |
Topical application of fluoride varnish |
401 |
369 |
$9K |
| D1351 |
Sealant - per tooth |
176 |
37 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
713 |
662 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
50 |
25 |
$3K |
| D1320 |
|
32 |
31 |
$767.10 |
| D1321 |
|
16 |
15 |
$495.20 |
| D0230 |
Intraoral - periapical each additional radiographic image |
45 |
26 |
$316.65 |