| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,083 |
1,606 |
$221K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,412 |
2,390 |
$83K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
977 |
586 |
$83K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,474 |
783 |
$79K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,187 |
510 |
$79K |
| D0210 |
Intraoral - complete series of radiographic images |
903 |
885 |
$49K |
| D0140 |
Limited oral evaluation - problem focused |
1,353 |
1,319 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,025 |
2,422 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
2,948 |
2,869 |
$33K |
| D1110 |
Prophylaxis - adult |
678 |
674 |
$30K |
| D0274 |
Bitewings - four radiographic images |
722 |
717 |
$21K |
| D1120 |
Prophylaxis - child |
310 |
310 |
$9K |
| D0270 |
|
499 |
496 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
43 |
27 |
$5K |
| D2331 |
|
46 |
30 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
153 |
153 |
$3K |
| D2332 |
|
18 |
12 |
$2K |
| D2394 |
|
15 |
12 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
12 |
12 |
$196.47 |