| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,152 |
729 |
$117K |
| D0140 |
Limited oral evaluation - problem focused |
2,711 |
2,545 |
$89K |
| D1110 |
Prophylaxis - adult |
1,538 |
1,464 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
3,897 |
3,554 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,144 |
1,085 |
$44K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
430 |
187 |
$43K |
| D0274 |
Bitewings - four radiographic images |
1,550 |
1,454 |
$42K |
| D0330 |
Panoramic radiographic image |
784 |
727 |
$36K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
277 |
190 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
1,196 |
1,144 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,379 |
1,726 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
319 |
197 |
$24K |
| D7311 |
|
169 |
136 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
228 |
128 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
110 |
109 |
$7K |
| D2335 |
|
20 |
12 |
$2K |
| D2332 |
|
21 |
12 |
$2K |
| D2331 |
|
19 |
14 |
$1K |
| D9110 |
|
16 |
14 |
$566.58 |