| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,848 |
838 |
$87K |
| D1110 |
Prophylaxis - adult |
1,761 |
1,583 |
$49K |
| D0210 |
Intraoral - complete series of radiographic images |
1,122 |
992 |
$49K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
553 |
351 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
650 |
323 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,388 |
1,257 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
697 |
420 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,282 |
1,132 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
1,358 |
1,225 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
1,019 |
877 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
797 |
739 |
$10K |
| D0330 |
Panoramic radiographic image |
231 |
208 |
$8K |
| D1120 |
Prophylaxis - child |
458 |
426 |
$8K |
| D2394 |
|
89 |
71 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
1,340 |
1,149 |
$5K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
12 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
928 |
460 |
$4K |
| D2335 |
|
16 |
12 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
15 |
12 |
$810.00 |