| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,014 |
999 |
$192K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,532 |
886 |
$106K |
| D0210 |
Intraoral - complete series of radiographic images |
2,314 |
2,266 |
$100K |
| D0140 |
Limited oral evaluation - problem focused |
3,848 |
3,779 |
$95K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,835 |
532 |
$91K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
821 |
491 |
$89K |
| D1110 |
Prophylaxis - adult |
2,256 |
2,247 |
$85K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,532 |
2,519 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
2,576 |
2,564 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
5,073 |
4,929 |
$49K |
| D0274 |
Bitewings - four radiographic images |
1,590 |
1,584 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,630 |
3,053 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
456 |
239 |
$30K |
| D2394 |
|
136 |
93 |
$18K |
| D1120 |
Prophylaxis - child |
371 |
371 |
$15K |
| D0330 |
Panoramic radiographic image |
348 |
348 |
$14K |
| D4355 |
|
271 |
269 |
$10K |
| D5110 |
|
12 |
12 |
$6K |
| D1206 |
Topical application of fluoride varnish |
257 |
257 |
$5K |
| D2332 |
|
62 |
28 |
$4K |
| D2950 |
|
27 |
24 |
$3K |
| D1351 |
Sealant - per tooth |
96 |
26 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
139 |
139 |
$2K |
| D2330 |
|
20 |
12 |
$1K |
| D0270 |
|
56 |
56 |
$693.98 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$256.70 |
| D7510 |
|
16 |
12 |
$182.06 |