| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,280 |
707 |
$98K |
| D1110 |
Prophylaxis - adult |
1,822 |
1,707 |
$93K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
764 |
450 |
$71K |
| D0210 |
Intraoral - complete series of radiographic images |
1,594 |
1,198 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,452 |
1,335 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
1,986 |
1,873 |
$49K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
284 |
104 |
$46K |
| D1351 |
Sealant - per tooth |
1,320 |
220 |
$35K |
| D4346 |
|
208 |
197 |
$32K |
| D0274 |
Bitewings - four radiographic images |
916 |
881 |
$32K |
| D1206 |
Topical application of fluoride varnish |
1,474 |
1,409 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
577 |
539 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,394 |
1,285 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,400 |
770 |
$14K |
| D1120 |
Prophylaxis - child |
292 |
281 |
$10K |
| D0330 |
Panoramic radiographic image |
155 |
152 |
$8K |
| D1999 |
|
170 |
136 |
$99.79 |