| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
11,135 |
5,189 |
$800K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,343 |
2,963 |
$451K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,790 |
3,257 |
$375K |
| D0210 |
Intraoral - complete series of radiographic images |
4,507 |
4,244 |
$341K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
10,047 |
9,593 |
$328K |
| D1110 |
Prophylaxis - adult |
7,021 |
6,623 |
$315K |
| D0330 |
Panoramic radiographic image |
5,158 |
4,978 |
$259K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,775 |
1,885 |
$232K |
| D0120 |
Periodic oral evaluation - established patient |
5,503 |
5,124 |
$133K |
| D0274 |
Bitewings - four radiographic images |
5,584 |
5,284 |
$131K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,974 |
4,719 |
$98K |
| D2331 |
|
1,104 |
543 |
$95K |
| D1120 |
Prophylaxis - child |
2,940 |
2,803 |
$75K |
| D4342 |
|
290 |
107 |
$31K |
| D1320 |
|
1,099 |
1,018 |
$22K |
| D2335 |
|
153 |
97 |
$18K |
| D2330 |
|
238 |
140 |
$17K |
| D2332 |
|
139 |
86 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
870 |
808 |
$7K |
| D0272 |
Bitewings - two radiographic images |
334 |
320 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
58 |
55 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
63 |
39 |
$616.33 |