| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,344 |
1,131 |
$146K |
| D1110 |
Prophylaxis - adult |
2,608 |
2,364 |
$107K |
| D0210 |
Intraoral - complete series of radiographic images |
1,723 |
1,532 |
$93K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,382 |
403 |
$90K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,134 |
1,913 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
2,721 |
2,427 |
$51K |
| D0274 |
Bitewings - four radiographic images |
1,742 |
1,547 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
979 |
886 |
$30K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
454 |
253 |
$28K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
296 |
141 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
324 |
164 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
812 |
687 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
816 |
747 |
$9K |
| D1120 |
Prophylaxis - child |
290 |
248 |
$4K |
| D0330 |
Panoramic radiographic image |
196 |
162 |
$3K |
| D0272 |
Bitewings - two radiographic images |
34 |
24 |
$148.86 |