| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,308 |
741 |
$76K |
| D1110 |
Prophylaxis - adult |
2,249 |
2,220 |
$75K |
| D0274 |
Bitewings - four radiographic images |
2,013 |
1,976 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
1,576 |
1,552 |
$30K |
| D0330 |
Panoramic radiographic image |
838 |
823 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,493 |
1,471 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
520 |
352 |
$26K |
| D9110 |
|
474 |
453 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,892 |
1,795 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
216 |
152 |
$13K |
| D1206 |
Topical application of fluoride varnish |
466 |
466 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
902 |
785 |
$7K |
| D1120 |
Prophylaxis - child |
255 |
255 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
94 |
58 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
129 |
124 |
$3K |
| D1330 |
|
449 |
446 |
$2K |
| D0601 |
|
150 |
149 |
$1K |
| D1310 |
|
223 |
221 |
$1K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
19 |
12 |
$1K |
| D2335 |
|
15 |
12 |
$1K |
| D1320 |
|
51 |
51 |
$838.61 |
| D4910 |
|
14 |
12 |
$524.94 |
| D0272 |
Bitewings - two radiographic images |
13 |
12 |
$190.92 |
| D0270 |
|
12 |
12 |
$95.58 |