| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,703 |
625 |
$89K |
| D1110 |
Prophylaxis - adult |
1,051 |
1,048 |
$80K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
855 |
435 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
891 |
888 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
855 |
854 |
$36K |
| D2394 |
|
426 |
303 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
708 |
704 |
$31K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
295 |
193 |
$23K |
| D2332 |
|
273 |
95 |
$20K |
| D0274 |
Bitewings - four radiographic images |
753 |
751 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
135 |
94 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,543 |
1,393 |
$12K |
| D2330 |
|
156 |
78 |
$11K |
| D1120 |
Prophylaxis - child |
378 |
376 |
$11K |
| D0350 |
|
399 |
264 |
$3K |
| D9430 |
|
98 |
96 |
$3K |
| D2335 |
|
23 |
13 |
$2K |
| D2951 |
|
15 |
12 |
$2K |
| D2331 |
|
18 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
28 |
28 |
$336.00 |