| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,312 |
2,054 |
$229K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,544 |
1,611 |
$217K |
| D4341 |
|
1,343 |
785 |
$201K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,250 |
1,152 |
$163K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,328 |
1,912 |
$156K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,879 |
4,481 |
$116K |
| D1120 |
Prophylaxis - child |
2,608 |
2,416 |
$103K |
| D0330 |
Panoramic radiographic image |
4,243 |
3,898 |
$101K |
| D1351 |
Sealant - per tooth |
1,358 |
563 |
$80K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,635 |
2,436 |
$64K |
| D1110 |
Prophylaxis - adult |
1,316 |
1,272 |
$58K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
724 |
556 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
1,975 |
1,902 |
$52K |
| D0274 |
Bitewings - four radiographic images |
2,974 |
2,775 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
2,583 |
1,857 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
1,123 |
1,106 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
3,512 |
3,231 |
$12K |
| D2331 |
|
136 |
91 |
$11K |
| D2330 |
|
187 |
126 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,899 |
2,631 |
$6K |
| D2332 |
|
59 |
49 |
$6K |
| D0272 |
Bitewings - two radiographic images |
399 |
370 |
$3K |
| D2335 |
|
16 |
12 |
$2K |
| D1206 |
Topical application of fluoride varnish |
15 |
14 |
$312.00 |