| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,611 |
983 |
$166K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,675 |
2,524 |
$112K |
| D0330 |
Panoramic radiographic image |
1,861 |
1,730 |
$89K |
| D1110 |
Prophylaxis - adult |
2,347 |
2,191 |
$86K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
514 |
384 |
$64K |
| D0274 |
Bitewings - four radiographic images |
1,865 |
1,739 |
$55K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
605 |
447 |
$48K |
| D7140 |
Extraction, erupted tooth or exposed root |
765 |
341 |
$45K |
| D1120 |
Prophylaxis - child |
1,191 |
1,139 |
$32K |
| D1206 |
Topical application of fluoride varnish |
1,809 |
1,735 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
874 |
802 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
1,457 |
1,360 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
869 |
810 |
$20K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
131 |
57 |
$14K |
| D0272 |
Bitewings - two radiographic images |
692 |
677 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
969 |
544 |
$11K |
| D2331 |
|
41 |
31 |
$3K |
| D2332 |
|
35 |
28 |
$3K |
| D2335 |
|
24 |
15 |
$3K |
| D2330 |
|
17 |
12 |
$1K |