| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,491 |
850 |
$57K |
| D0330 |
Panoramic radiographic image |
1,085 |
1,077 |
$51K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
572 |
395 |
$47K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,547 |
797 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
852 |
834 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
370 |
368 |
$20K |
| D2332 |
|
269 |
126 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
1,885 |
1,498 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,397 |
1,388 |
$10K |
| D1110 |
Prophylaxis - adult |
1,953 |
1,932 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
90 |
55 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,634 |
1,611 |
$2K |
| D0274 |
Bitewings - four radiographic images |
927 |
917 |
$2K |
| D4341 |
|
135 |
38 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
865 |
803 |
$1K |
| D2335 |
|
34 |
13 |
$1K |
| D2330 |
|
27 |
14 |
$701.50 |
| D1330 |
|
1,084 |
1,065 |
$364.10 |
| D0220 |
Intraoral - periapical first radiographic image |
1,107 |
1,031 |
$323.65 |
| D0180 |
|
101 |
99 |
$165.75 |
| D1120 |
Prophylaxis - child |
44 |
43 |
$105.56 |
| D3120 |
|
1,310 |
569 |
$43.05 |
| D9215 |
|
1,026 |
821 |
$0.00 |
| D1310 |
|
463 |
452 |
$0.00 |
| D1999 |
|
844 |
631 |
$0.00 |
| D0270 |
|
12 |
12 |
$0.00 |