| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,508 |
1,386 |
$311K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,877 |
1,049 |
$186K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,518 |
2,366 |
$82K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,380 |
1,013 |
$81K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
782 |
436 |
$76K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
168 |
118 |
$70K |
| D0330 |
Panoramic radiographic image |
1,102 |
1,043 |
$37K |
| D1110 |
Prophylaxis - adult |
969 |
917 |
$36K |
| D0274 |
Bitewings - four radiographic images |
1,680 |
1,584 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
770 |
710 |
$24K |
| D2330 |
|
439 |
242 |
$23K |
| D3320 |
|
29 |
27 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
727 |
707 |
$16K |
| D7230 |
|
40 |
28 |
$9K |
| D2331 |
|
83 |
58 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
358 |
348 |
$6K |
| D1120 |
Prophylaxis - child |
138 |
134 |
$6K |
| D0272 |
Bitewings - two radiographic images |
123 |
123 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
583 |
551 |
$2K |
| D1206 |
Topical application of fluoride varnish |
57 |
56 |
$1K |
| D0160 |
|
15 |
15 |
$390.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,670 |
234 |
$230.40 |