| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,888 |
951 |
$96K |
| D0210 |
Intraoral - complete series of radiographic images |
1,743 |
1,670 |
$87K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,197 |
1,067 |
$76K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,077 |
703 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,495 |
2,419 |
$66K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
823 |
477 |
$49K |
| D1110 |
Prophylaxis - adult |
1,074 |
1,037 |
$44K |
| D0330 |
Panoramic radiographic image |
1,015 |
976 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
1,043 |
999 |
$36K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
887 |
461 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
1,026 |
986 |
$19K |
| D1120 |
Prophylaxis - child |
325 |
320 |
$18K |
| D0274 |
Bitewings - four radiographic images |
801 |
773 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,988 |
1,805 |
$13K |
| D1206 |
Topical application of fluoride varnish |
549 |
541 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
841 |
520 |
$4K |
| D7250 |
|
39 |
26 |
$3K |
| D2331 |
|
54 |
39 |
$3K |
| D2332 |
|
28 |
18 |
$1K |
| D2394 |
|
14 |
12 |
$971.40 |
| D0272 |
Bitewings - two radiographic images |
48 |
48 |
$806.26 |
| D0270 |
|
19 |
14 |
$49.57 |