| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,685 |
2,406 |
$307K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,822 |
2,073 |
$217K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,114 |
1,185 |
$152K |
| D1110 |
Prophylaxis - adult |
3,945 |
3,927 |
$150K |
| D0140 |
Limited oral evaluation - problem focused |
4,855 |
4,689 |
$134K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,114 |
877 |
$120K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,830 |
3,817 |
$111K |
| D0120 |
Periodic oral evaluation - established patient |
4,577 |
4,557 |
$102K |
| D0330 |
Panoramic radiographic image |
2,510 |
2,496 |
$99K |
| D0274 |
Bitewings - four radiographic images |
4,153 |
4,134 |
$92K |
| D0220 |
Intraoral - periapical first radiographic image |
8,140 |
7,838 |
$80K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,179 |
6,205 |
$44K |
| D1120 |
Prophylaxis - child |
990 |
989 |
$40K |
| D0210 |
Intraoral - complete series of radiographic images |
1,171 |
1,046 |
$39K |
| D1206 |
Topical application of fluoride varnish |
1,431 |
1,430 |
$31K |
| D4341 |
|
198 |
64 |
$27K |
| D4910 |
|
311 |
310 |
$24K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
441 |
306 |
$24K |
| D7250 |
|
95 |
63 |
$7K |
| D2331 |
|
50 |
39 |
$4K |
| D2330 |
|
78 |
50 |
$4K |
| D4355 |
|
78 |
78 |
$3K |
| D0272 |
Bitewings - two radiographic images |
126 |
126 |
$3K |