| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,439 |
863 |
$108K |
| D1110 |
Prophylaxis - adult |
2,831 |
2,725 |
$96K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,431 |
684 |
$87K |
| D0120 |
Periodic oral evaluation - established patient |
3,568 |
3,449 |
$84K |
| D0210 |
Intraoral - complete series of radiographic images |
795 |
752 |
$44K |
| D1120 |
Prophylaxis - child |
1,042 |
1,008 |
$44K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
316 |
202 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
830 |
802 |
$22K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
345 |
193 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
705 |
667 |
$19K |
| D0274 |
Bitewings - four radiographic images |
605 |
592 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
403 |
394 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
955 |
898 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
99 |
60 |
$9K |
| D2160 |
|
73 |
40 |
$4K |
| D2330 |
|
42 |
24 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
176 |
126 |
$2K |
| D0272 |
Bitewings - two radiographic images |
93 |
75 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
12 |
$1K |
| D2140 |
|
18 |
13 |
$849.68 |