| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,563 |
2,198 |
$302K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,500 |
4,480 |
$299K |
| D0120 |
Periodic oral evaluation - established patient |
3,645 |
3,609 |
$248K |
| D1120 |
Prophylaxis - child |
5,195 |
5,155 |
$241K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,354 |
1,847 |
$233K |
| D1110 |
Prophylaxis - adult |
2,144 |
2,135 |
$189K |
| D0210 |
Intraoral - complete series of radiographic images |
3,270 |
3,256 |
$156K |
| D1206 |
Topical application of fluoride varnish |
7,026 |
6,970 |
$129K |
| D1351 |
Sealant - per tooth |
2,388 |
588 |
$90K |
| D1310 |
|
1,613 |
1,602 |
$72K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,190 |
604 |
$68K |
| D0274 |
Bitewings - four radiographic images |
2,599 |
2,581 |
$51K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
644 |
416 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,483 |
4,211 |
$44K |
| D0350 |
|
2,555 |
873 |
$22K |
| D0603 |
|
1,412 |
1,403 |
$20K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
148 |
106 |
$17K |
| D1320 |
|
928 |
925 |
$15K |
| D0145 |
Oral evaluation for a patient under three years of age |
210 |
206 |
$14K |
| D4910 |
|
163 |
163 |
$13K |
| D4341 |
|
149 |
42 |
$10K |
| D9993 |
|
188 |
188 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
847 |
842 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
578 |
578 |
$7K |
| D2330 |
|
72 |
43 |
$5K |
| D0272 |
Bitewings - two radiographic images |
234 |
234 |
$3K |
| D2331 |
|
22 |
13 |
$2K |
| D3221 |
|
22 |
15 |
$1K |
| D1999 |
|
5,196 |
4,460 |
$1K |
| D2940 |
|
14 |
12 |
$697.50 |
| D0601 |
|
43 |
41 |
$645.00 |
| D0602 |
|
16 |
16 |
$225.00 |