| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,948 |
1,118 |
$141K |
| D0330 |
Panoramic radiographic image |
3,965 |
2,501 |
$114K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,199 |
2,303 |
$102K |
| D0140 |
Limited oral evaluation - problem focused |
4,193 |
3,407 |
$102K |
| D0274 |
Bitewings - four radiographic images |
3,507 |
3,043 |
$95K |
| D1120 |
Prophylaxis - child |
1,876 |
1,745 |
$75K |
| D1110 |
Prophylaxis - adult |
2,416 |
2,098 |
$71K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,627 |
3,261 |
$67K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,094 |
587 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
2,298 |
2,089 |
$53K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
191 |
90 |
$50K |
| D0220 |
Intraoral - periapical first radiographic image |
3,154 |
2,673 |
$31K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
653 |
213 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
384 |
155 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,022 |
575 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
96 |
64 |
$8K |
| D2954 |
|
74 |
40 |
$7K |
| D3320 |
|
22 |
12 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
58 |
37 |
$3K |
| D1351 |
Sealant - per tooth |
59 |
13 |
$2K |
| D3110 |
|
19 |
13 |
$1K |
| D0272 |
Bitewings - two radiographic images |
29 |
29 |
$850.56 |