| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,020 |
815 |
$45K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,191 |
547 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,552 |
1,539 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
1,602 |
1,566 |
$22K |
| D1110 |
Prophylaxis - adult |
1,673 |
1,653 |
$20K |
| D1120 |
Prophylaxis - child |
1,740 |
1,718 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
2,382 |
2,352 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
688 |
686 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,722 |
1,701 |
$11K |
| D0274 |
Bitewings - four radiographic images |
1,733 |
1,712 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
446 |
371 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
64 |
39 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
114 |
100 |
$7K |
| D4341 |
|
352 |
181 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
1,009 |
989 |
$5K |
| D0272 |
Bitewings - two radiographic images |
509 |
505 |
$4K |
| D0330 |
Panoramic radiographic image |
738 |
720 |
$1K |
| D1206 |
Topical application of fluoride varnish |
677 |
675 |
$616.42 |
| D4910 |
|
150 |
148 |
$488.00 |
| D1354 |
|
48 |
26 |
$0.00 |
| D0191 |
|
453 |
452 |
$0.00 |
| D0603 |
|
67 |
67 |
$0.00 |
| D0601 |
|
150 |
150 |
$0.00 |
| D1310 |
|
163 |
162 |
$0.00 |
| D1330 |
|
205 |
203 |
$0.00 |
| D1351 |
Sealant - per tooth |
292 |
87 |
$0.00 |
| D0602 |
|
211 |
210 |
$0.00 |