| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,188 |
547 |
$120K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
925 |
438 |
$112K |
| D0330 |
Panoramic radiographic image |
1,392 |
1,293 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,150 |
1,075 |
$48K |
| D0274 |
Bitewings - four radiographic images |
1,661 |
1,569 |
$47K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,262 |
2,242 |
$45K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
406 |
184 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
2,915 |
2,684 |
$42K |
| D1110 |
Prophylaxis - adult |
1,169 |
1,097 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
1,615 |
1,484 |
$38K |
| D2394 |
|
212 |
94 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
851 |
767 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
286 |
126 |
$19K |
| D4355 |
|
200 |
197 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
132 |
51 |
$10K |
| D7311 |
|
87 |
63 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
470 |
429 |
$7K |
| D1120 |
Prophylaxis - child |
88 |
84 |
$2K |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$232.20 |