| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2332 |
|
804 |
287 |
$76K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,004 |
244 |
$64K |
| D7140 |
Extraction, erupted tooth or exposed root |
693 |
191 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
1,384 |
1,274 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,510 |
1,489 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,901 |
910 |
$26K |
| D7971 |
|
85 |
82 |
$26K |
| D1110 |
Prophylaxis - adult |
797 |
778 |
$24K |
| D0274 |
Bitewings - four radiographic images |
870 |
858 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
2,074 |
1,222 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
452 |
448 |
$21K |
| D0330 |
Panoramic radiographic image |
1,256 |
1,146 |
$16K |
| D2140 |
|
297 |
92 |
$15K |
| D9941 |
|
26 |
24 |
$7K |
| D1120 |
Prophylaxis - child |
150 |
150 |
$6K |
| D1351 |
Sealant - per tooth |
146 |
30 |
$6K |
| D2335 |
|
48 |
26 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
101 |
99 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
96 |
88 |
$2K |
| D2940 |
|
20 |
13 |
$566.00 |