| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,772 |
1,292 |
$65K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
421 |
118 |
$32K |
| D1110 |
Prophylaxis - adult |
777 |
570 |
$30K |
| D0330 |
Panoramic radiographic image |
804 |
600 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
378 |
118 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
536 |
477 |
$20K |
| D0274 |
Bitewings - four radiographic images |
993 |
731 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
180 |
48 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
848 |
608 |
$6K |
| D2335 |
|
51 |
13 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
747 |
498 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
53 |
17 |
$4K |
| D2394 |
|
42 |
13 |
$3K |
| D2332 |
|
36 |
12 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
46 |
37 |
$1K |