| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,882 |
997 |
$105K |
| D1120 |
Prophylaxis - child |
1,953 |
1,837 |
$89K |
| D0330 |
Panoramic radiographic image |
2,345 |
2,165 |
$86K |
| D1110 |
Prophylaxis - adult |
1,892 |
1,714 |
$75K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,626 |
770 |
$74K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,841 |
588 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,589 |
2,394 |
$64K |
| D9110 |
|
1,945 |
1,718 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,328 |
2,182 |
$33K |
| D0272 |
Bitewings - two radiographic images |
1,776 |
1,640 |
$27K |
| D0120 |
Periodic oral evaluation - established patient |
1,185 |
1,104 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
331 |
211 |
$20K |
| D0274 |
Bitewings - four radiographic images |
280 |
264 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
859 |
785 |
$6K |
| D2394 |
|
87 |
50 |
$6K |
| D2335 |
|
89 |
37 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
44 |
25 |
$3K |
| D7250 |
|
29 |
12 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
29 |
29 |
$1K |
| D2332 |
|
38 |
12 |
$1K |
| D9986 |
|
17 |
16 |
$42.00 |