| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,307 |
910 |
$178K |
| D1110 |
Prophylaxis - adult |
3,162 |
3,150 |
$146K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,289 |
767 |
$137K |
| D0120 |
Periodic oral evaluation - established patient |
4,991 |
4,958 |
$122K |
| D4910 |
|
1,655 |
1,636 |
$118K |
| D2750 |
|
169 |
148 |
$112K |
| D4342 |
|
1,012 |
403 |
$96K |
| D0274 |
Bitewings - four radiographic images |
2,547 |
2,533 |
$77K |
| D0140 |
Limited oral evaluation - problem focused |
1,866 |
1,854 |
$66K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,343 |
1,339 |
$54K |
| D1206 |
Topical application of fluoride varnish |
1,519 |
1,514 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
337 |
336 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
2,085 |
2,046 |
$26K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
137 |
100 |
$23K |
| D2950 |
|
125 |
111 |
$17K |
| D1120 |
Prophylaxis - child |
401 |
401 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
111 |
50 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
66 |
64 |
$1K |