| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,793 |
922 |
$119K |
| D1110 |
Prophylaxis - adult |
1,122 |
1,121 |
$82K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
934 |
617 |
$73K |
| D4341 |
|
875 |
238 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
1,256 |
1,256 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
813 |
812 |
$44K |
| D0210 |
Intraoral - complete series of radiographic images |
798 |
798 |
$36K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
246 |
144 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
494 |
277 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,683 |
1,863 |
$23K |
| D1120 |
Prophylaxis - child |
509 |
509 |
$15K |
| D2394 |
|
179 |
142 |
$15K |
| D0274 |
Bitewings - four radiographic images |
692 |
691 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,192 |
1,147 |
$14K |
| D3320 |
|
16 |
14 |
$6K |
| D4910 |
|
72 |
72 |
$6K |
| D0240 |
|
520 |
326 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
505 |
505 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
42 |
15 |
$2K |
| D9430 |
|
42 |
42 |
$1K |
| D0270 |
|
26 |
25 |
$130.00 |