| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
957 |
430 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,434 |
1,382 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
1,142 |
1,100 |
$29K |
| D1110 |
Prophylaxis - adult |
920 |
888 |
$27K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
486 |
176 |
$25K |
| D4341 |
|
1,167 |
294 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
368 |
151 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
772 |
756 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
858 |
785 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,097 |
1,049 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
327 |
185 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,286 |
1,240 |
$8K |
| D0274 |
Bitewings - four radiographic images |
720 |
704 |
$7K |
| D1120 |
Prophylaxis - child |
164 |
159 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,641 |
844 |
$3K |
| D0330 |
Panoramic radiographic image |
585 |
559 |
$2K |
| D1351 |
Sealant - per tooth |
50 |
13 |
$813.26 |
| D0270 |
|
21 |
19 |
$103.44 |