| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
1,065 |
1,027 |
$62K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
807 |
446 |
$48K |
| D7140 |
Extraction, erupted tooth or exposed root |
634 |
131 |
$44K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
279 |
93 |
$38K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
398 |
246 |
$26K |
| D1110 |
Prophylaxis - adult |
542 |
525 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
618 |
596 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
879 |
850 |
$24K |
| D0274 |
Bitewings - four radiographic images |
636 |
614 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
271 |
142 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
392 |
380 |
$4K |
| D2332 |
|
26 |
14 |
$2K |
| D1206 |
Topical application of fluoride varnish |
61 |
60 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
47 |
44 |
$613.50 |
| D1120 |
Prophylaxis - child |
12 |
12 |
$492.90 |