| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,158 |
393 |
$188K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
820 |
815 |
$30K |
| D1110 |
Prophylaxis - adult |
580 |
576 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
406 |
401 |
$25K |
| D5214 |
|
17 |
17 |
$18K |
| D5213 |
|
15 |
15 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,318 |
1,281 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,221 |
831 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
101 |
62 |
$11K |
| D1120 |
Prophylaxis - child |
276 |
273 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
139 |
85 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
319 |
312 |
$8K |
| D1352 |
|
123 |
15 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
73 |
41 |
$6K |
| D4355 |
|
126 |
125 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
250 |
248 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
170 |
170 |
$4K |
| D0272 |
Bitewings - two radiographic images |
112 |
111 |
$2K |
| D2950 |
|
12 |
12 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$1K |
| D0274 |
Bitewings - four radiographic images |
26 |
26 |
$594.24 |