| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,464 |
812 |
$89K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,011 |
327 |
$82K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,521 |
1,367 |
$56K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,665 |
2,517 |
$49K |
| D1110 |
Prophylaxis - adult |
1,596 |
1,485 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
1,751 |
1,533 |
$41K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
474 |
295 |
$26K |
| D0274 |
Bitewings - four radiographic images |
859 |
810 |
$24K |
| D1120 |
Prophylaxis - child |
571 |
555 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
538 |
499 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
850 |
816 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
243 |
180 |
$18K |
| D0330 |
Panoramic radiographic image |
350 |
281 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,044 |
916 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
66 |
42 |
$703.24 |
| D0272 |
Bitewings - two radiographic images |
24 |
23 |
$627.20 |