| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,150 |
716 |
$81K |
| D1110 |
Prophylaxis - adult |
1,888 |
1,851 |
$62K |
| D0274 |
Bitewings - four radiographic images |
1,847 |
1,811 |
$48K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
438 |
282 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
1,807 |
1,781 |
$34K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
337 |
275 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,954 |
1,860 |
$23K |
| D0330 |
Panoramic radiographic image |
594 |
589 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
2,398 |
2,314 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
333 |
270 |
$18K |
| D1351 |
Sealant - per tooth |
601 |
103 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
463 |
447 |
$9K |
| D5110 |
|
15 |
15 |
$8K |
| D5120 |
|
13 |
13 |
$7K |
| D1330 |
|
976 |
954 |
$5K |
| D9110 |
|
177 |
177 |
$5K |
| D2332 |
|
53 |
47 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
295 |
291 |
$5K |
| D1120 |
Prophylaxis - child |
190 |
189 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
161 |
159 |
$4K |
| D0601 |
|
140 |
139 |
$1K |
| D1310 |
|
55 |
55 |
$326.00 |
| D0270 |
|
34 |
34 |
$265.00 |
| D9310 |
|
31 |
31 |
$0.00 |