| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,171 |
1,807 |
$298K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,625 |
1,590 |
$211K |
| D0210 |
Intraoral - complete series of radiographic images |
2,382 |
2,287 |
$111K |
| D1110 |
Prophylaxis - adult |
2,895 |
2,801 |
$96K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,976 |
2,366 |
$88K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
901 |
529 |
$78K |
| D0120 |
Periodic oral evaluation - established patient |
1,770 |
1,731 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,189 |
1,165 |
$35K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
638 |
285 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
886 |
863 |
$25K |
| D1120 |
Prophylaxis - child |
478 |
460 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
479 |
461 |
$12K |
| D9243 |
|
36 |
30 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
728 |
553 |
$7K |
| D9310 |
|
240 |
220 |
$5K |
| D7230 |
|
24 |
13 |
$4K |
| D9239 |
|
35 |
29 |
$2K |
| D2140 |
|
52 |
26 |
$2K |
| D0270 |
|
198 |
195 |
$1K |