| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,913 |
1,111 |
$158K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,061 |
707 |
$105K |
| D1110 |
Prophylaxis - adult |
2,084 |
1,987 |
$103K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,444 |
2,344 |
$97K |
| D0210 |
Intraoral - complete series of radiographic images |
1,722 |
1,431 |
$88K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
922 |
634 |
$57K |
| D0140 |
Limited oral evaluation - problem focused |
1,413 |
1,343 |
$52K |
| D0120 |
Periodic oral evaluation - established patient |
1,760 |
1,674 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,249 |
1,192 |
$41K |
| D1206 |
Topical application of fluoride varnish |
1,795 |
1,726 |
$36K |
| D1120 |
Prophylaxis - child |
918 |
885 |
$31K |
| D0330 |
Panoramic radiographic image |
527 |
503 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
182 |
118 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,333 |
1,235 |
$17K |
| D2394 |
|
138 |
94 |
$15K |
| D0272 |
Bitewings - two radiographic images |
541 |
514 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
51 |
28 |
$10K |
| D2331 |
|
93 |
59 |
$10K |
| D4346 |
|
29 |
27 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
293 |
205 |
$3K |
| D2332 |
|
18 |
12 |
$2K |
| D2330 |
|
16 |
12 |
$1K |