| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,098 |
414 |
$71K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,011 |
362 |
$54K |
| D1110 |
Prophylaxis - adult |
1,351 |
1,340 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,629 |
1,608 |
$42K |
| D0330 |
Panoramic radiographic image |
570 |
555 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
587 |
560 |
$22K |
| D1320 |
|
1,444 |
1,429 |
$21K |
| D0274 |
Bitewings - four radiographic images |
971 |
963 |
$18K |
| D1321 |
|
766 |
765 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
165 |
74 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
146 |
52 |
$8K |
| D1206 |
Topical application of fluoride varnish |
458 |
449 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
239 |
236 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
175 |
175 |
$3K |
| D1351 |
Sealant - per tooth |
133 |
29 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
59 |
28 |
$3K |
| D2160 |
|
30 |
14 |
$2K |
| D1120 |
Prophylaxis - child |
86 |
85 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
293 |
292 |
$1K |
| D2140 |
|
30 |
14 |
$1K |
| D1999 |
|
13 |
13 |
$0.00 |