| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,820 |
1,572 |
$299K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,639 |
1,340 |
$211K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,838 |
2,712 |
$119K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
721 |
491 |
$93K |
| D0210 |
Intraoral - complete series of radiographic images |
1,450 |
1,386 |
$84K |
| D1110 |
Prophylaxis - adult |
1,953 |
1,912 |
$73K |
| D0274 |
Bitewings - four radiographic images |
1,481 |
1,421 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
1,026 |
990 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
2,321 |
2,075 |
$32K |
| D0330 |
Panoramic radiographic image |
604 |
591 |
$28K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,269 |
1,382 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
958 |
956 |
$24K |
| D2332 |
|
190 |
139 |
$19K |
| D4355 |
|
276 |
268 |
$18K |
| D4341 |
|
128 |
49 |
$13K |
| D1206 |
Topical application of fluoride varnish |
855 |
832 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
99 |
53 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
79 |
34 |
$5K |
| D7250 |
|
37 |
12 |
$4K |
| D2330 |
|
41 |
22 |
$3K |
| D2335 |
|
16 |
12 |
$2K |
| D4342 |
|
29 |
13 |
$2K |
| D0270 |
|
174 |
171 |
$1K |