| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
928 |
542 |
$73K |
| D1110 |
Prophylaxis - adult |
1,681 |
1,635 |
$62K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
642 |
420 |
$59K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
511 |
305 |
$32K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
318 |
153 |
$28K |
| D0330 |
Panoramic radiographic image |
695 |
675 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
1,096 |
1,068 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
770 |
745 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
729 |
675 |
$15K |
| D0274 |
Bitewings - four radiographic images |
913 |
890 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
582 |
573 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
142 |
67 |
$10K |
| D2332 |
|
82 |
51 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
870 |
821 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
50 |
47 |
$336.00 |
| D1999 |
|
27 |
25 |
$0.00 |