| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,934 |
1,347 |
$144K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,800 |
827 |
$133K |
| D1110 |
Prophylaxis - adult |
4,352 |
4,055 |
$126K |
| D0210 |
Intraoral - complete series of radiographic images |
2,931 |
2,650 |
$108K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,973 |
4,583 |
$104K |
| D0330 |
Panoramic radiographic image |
2,017 |
1,874 |
$79K |
| D0140 |
Limited oral evaluation - problem focused |
2,996 |
2,743 |
$54K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
787 |
522 |
$48K |
| D1351 |
Sealant - per tooth |
2,358 |
263 |
$44K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,104 |
498 |
$39K |
| D1120 |
Prophylaxis - child |
1,623 |
1,482 |
$39K |
| D7140 |
Extraction, erupted tooth or exposed root |
965 |
433 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
2,126 |
1,957 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
3,996 |
3,665 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,816 |
1,706 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,280 |
2,087 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,081 |
1,822 |
$13K |
| D1206 |
Topical application of fluoride varnish |
512 |
498 |
$8K |
| D2394 |
|
68 |
55 |
$5K |