| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,000 |
942 |
$167K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,584 |
649 |
$98K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
902 |
550 |
$74K |
| D0210 |
Intraoral - complete series of radiographic images |
1,335 |
1,308 |
$60K |
| D1110 |
Prophylaxis - adult |
1,152 |
1,145 |
$44K |
| D4355 |
|
629 |
603 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,147 |
1,136 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
1,224 |
1,182 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
1,221 |
1,209 |
$27K |
| D1120 |
Prophylaxis - child |
523 |
515 |
$20K |
| D2332 |
|
184 |
92 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
518 |
510 |
$12K |
| D0274 |
Bitewings - four radiographic images |
300 |
298 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
47 |
24 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
386 |
373 |
$4K |
| D1206 |
Topical application of fluoride varnish |
26 |
26 |
$650.00 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$323.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
54 |
52 |
$270.13 |