| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,139 |
732 |
$121K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,051 |
683 |
$85K |
| D0210 |
Intraoral - complete series of radiographic images |
1,175 |
1,142 |
$84K |
| D1110 |
Prophylaxis - adult |
2,176 |
2,119 |
$83K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,920 |
1,863 |
$82K |
| D0330 |
Panoramic radiographic image |
1,298 |
1,269 |
$76K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
485 |
369 |
$63K |
| D0140 |
Limited oral evaluation - problem focused |
1,392 |
1,361 |
$50K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
380 |
150 |
$38K |
| D7140 |
Extraction, erupted tooth or exposed root |
576 |
223 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
1,157 |
1,142 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
1,286 |
1,254 |
$19K |
| D7250 |
|
180 |
38 |
$18K |
| D4355 |
|
245 |
242 |
$17K |
| D0274 |
Bitewings - four radiographic images |
479 |
471 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
839 |
818 |
$14K |
| D2330 |
|
174 |
124 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
880 |
408 |
$10K |
| D1120 |
Prophylaxis - child |
362 |
353 |
$10K |
| D4341 |
|
94 |
48 |
$10K |
| D5120 |
|
13 |
12 |
$7K |
| D2335 |
|
56 |
39 |
$7K |
| D5212 |
|
14 |
12 |
$5K |
| D2331 |
|
58 |
38 |
$5K |
| D2332 |
|
36 |
24 |
$4K |
| D4342 |
|
58 |
27 |
$3K |
| D0272 |
Bitewings - two radiographic images |
101 |
99 |
$2K |