| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,684 |
1,141 |
$195K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,767 |
2,662 |
$174K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,367 |
932 |
$155K |
| D1110 |
Prophylaxis - adult |
1,853 |
1,793 |
$149K |
| D0210 |
Intraoral - complete series of radiographic images |
2,446 |
2,327 |
$103K |
| D2330 |
|
1,106 |
233 |
$82K |
| D4341 |
|
1,095 |
309 |
$77K |
| D2331 |
|
950 |
239 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
584 |
570 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,926 |
1,873 |
$26K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
253 |
110 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
337 |
139 |
$19K |
| D9430 |
|
344 |
327 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
94 |
52 |
$11K |
| D1120 |
Prophylaxis - child |
204 |
202 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,651 |
645 |
$7K |
| D0274 |
Bitewings - four radiographic images |
235 |
228 |
$5K |
| D4910 |
|
30 |
30 |
$2K |
| D2140 |
|
25 |
17 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
18 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
13 |
$156.00 |
| D1330 |
|
1,114 |
1,091 |
$0.00 |