| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,306 |
770 |
$123K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,840 |
1,831 |
$119K |
| D0210 |
Intraoral - complete series of radiographic images |
1,766 |
1,757 |
$82K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,008 |
492 |
$66K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
440 |
219 |
$50K |
| D9430 |
|
1,349 |
1,199 |
$43K |
| D1110 |
Prophylaxis - adult |
352 |
348 |
$31K |
| D0350 |
|
2,577 |
857 |
$25K |
| D1120 |
Prophylaxis - child |
396 |
396 |
$20K |
| D0330 |
Panoramic radiographic image |
569 |
560 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
208 |
207 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
785 |
782 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
681 |
635 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,435 |
497 |
$6K |
| D2330 |
|
75 |
43 |
$6K |
| D4341 |
|
29 |
12 |
$2K |
| D4910 |
|
24 |
24 |
$2K |
| D0272 |
Bitewings - two radiographic images |
31 |
31 |
$338.00 |