| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,024 |
504 |
$97K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,100 |
187 |
$85K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
953 |
476 |
$73K |
| D0210 |
Intraoral - complete series of radiographic images |
864 |
778 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,644 |
1,492 |
$53K |
| D1110 |
Prophylaxis - adult |
1,120 |
1,010 |
$53K |
| D0330 |
Panoramic radiographic image |
767 |
697 |
$41K |
| D0140 |
Limited oral evaluation - problem focused |
566 |
515 |
$20K |
| D0274 |
Bitewings - four radiographic images |
701 |
627 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,718 |
535 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
613 |
568 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
194 |
99 |
$15K |
| D2394 |
|
70 |
52 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
399 |
364 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
930 |
853 |
$7K |
| D4342 |
|
31 |
12 |
$4K |
| D2332 |
|
25 |
12 |
$4K |
| D1120 |
Prophylaxis - child |
130 |
120 |
$3K |
| D0180 |
|
16 |
13 |
$843.40 |