| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,382 |
579 |
$98K |
| D9410 |
|
879 |
681 |
$82K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,392 |
593 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,060 |
1,055 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,005 |
1,003 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
1,785 |
1,696 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,565 |
1,329 |
$16K |
| D1110 |
Prophylaxis - adult |
317 |
314 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
505 |
502 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
66 |
42 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
82 |
82 |
$4K |
| D9110 |
|
65 |
64 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
28 |
15 |
$3K |
| D4346 |
|
26 |
18 |
$3K |
| D2332 |
|
19 |
13 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
44 |
42 |
$1K |
| D9995 |
|
30 |
30 |
$866.51 |