| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,348 |
735 |
$70K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,966 |
830 |
$66K |
| D0210 |
Intraoral - complete series of radiographic images |
1,011 |
993 |
$56K |
| D1110 |
Prophylaxis - adult |
1,069 |
1,052 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,680 |
1,648 |
$46K |
| D0330 |
Panoramic radiographic image |
702 |
687 |
$31K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
487 |
335 |
$31K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
508 |
325 |
$30K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
738 |
429 |
$30K |
| D0274 |
Bitewings - four radiographic images |
1,028 |
1,006 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
785 |
753 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
954 |
940 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,467 |
1,405 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,026 |
544 |
$6K |
| D1120 |
Prophylaxis - child |
130 |
127 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
228 |
223 |
$3K |
| D2332 |
|
40 |
24 |
$3K |
| D1206 |
Topical application of fluoride varnish |
111 |
109 |
$2K |
| D4341 |
|
50 |
14 |
$1K |
| D2331 |
|
17 |
12 |
$861.85 |
| D2330 |
|
17 |
12 |
$658.68 |
| D0270 |
|
39 |
38 |
$203.28 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$182.91 |