| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,663 |
1,880 |
$261K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,899 |
4,890 |
$169K |
| D0210 |
Intraoral - complete series of radiographic images |
2,038 |
2,002 |
$112K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,763 |
912 |
$95K |
| D0274 |
Bitewings - four radiographic images |
2,664 |
2,658 |
$77K |
| D0220 |
Intraoral - periapical first radiographic image |
6,289 |
6,102 |
$71K |
| D1110 |
Prophylaxis - adult |
1,230 |
1,226 |
$54K |
| D7140 |
Extraction, erupted tooth or exposed root |
799 |
325 |
$51K |
| D9110 |
|
895 |
871 |
$49K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
421 |
211 |
$46K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
514 |
337 |
$45K |
| D0140 |
Limited oral evaluation - problem focused |
1,573 |
1,547 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,396 |
2,390 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,900 |
3,690 |
$36K |
| D1120 |
Prophylaxis - child |
732 |
728 |
$23K |
| D2335 |
|
38 |
26 |
$5K |
| D4341 |
|
28 |
12 |
$4K |
| D4346 |
|
25 |
25 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
39 |
39 |
$792.28 |