| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
675 |
440 |
$89K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
628 |
369 |
$64K |
| D7140 |
Extraction, erupted tooth or exposed root |
426 |
147 |
$55K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
190 |
146 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
444 |
443 |
$24K |
| D1110 |
Prophylaxis - adult |
330 |
330 |
$21K |
| D0274 |
Bitewings - four radiographic images |
437 |
432 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
899 |
856 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
189 |
183 |
$8K |
| D0330 |
Panoramic radiographic image |
181 |
177 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
565 |
549 |
$5K |
| D2332 |
|
23 |
13 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
49 |
49 |
$1K |