| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,890 |
969 |
$93K |
| D1110 |
Prophylaxis - adult |
2,447 |
2,220 |
$86K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,202 |
731 |
$67K |
| D0330 |
Panoramic radiographic image |
2,058 |
1,878 |
$67K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,882 |
2,620 |
$63K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,161 |
602 |
$47K |
| D0274 |
Bitewings - four radiographic images |
2,276 |
2,071 |
$46K |
| D2335 |
|
528 |
295 |
$36K |
| D2332 |
|
531 |
286 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
1,095 |
990 |
$30K |
| D2394 |
|
372 |
249 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,574 |
1,432 |
$21K |
| D1120 |
Prophylaxis - child |
364 |
337 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
88 |
40 |
$6K |
| D1351 |
Sealant - per tooth |
117 |
30 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
187 |
176 |
$1K |
| D9986 |
|
281 |
231 |
$0.00 |