| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,032 |
620 |
$135K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,325 |
483 |
$111K |
| D2394 |
|
589 |
236 |
$59K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
709 |
114 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
1,575 |
1,529 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
683 |
331 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
891 |
850 |
$33K |
| D1110 |
Prophylaxis - adult |
1,060 |
1,025 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
593 |
196 |
$28K |
| D1120 |
Prophylaxis - child |
1,203 |
1,161 |
$25K |
| D0274 |
Bitewings - four radiographic images |
1,185 |
1,139 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
2,508 |
2,406 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,523 |
2,261 |
$18K |
| D0330 |
Panoramic radiographic image |
498 |
478 |
$16K |
| D0272 |
Bitewings - two radiographic images |
1,083 |
1,049 |
$15K |
| D1206 |
Topical application of fluoride varnish |
1,010 |
988 |
$13K |
| D2330 |
|
232 |
111 |
$11K |
| D2331 |
|
179 |
90 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
298 |
276 |
$7K |
| D2332 |
|
89 |
40 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
243 |
220 |
$6K |
| D3120 |
|
31 |
17 |
$780.58 |