| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,681 |
758 |
$106K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,186 |
436 |
$77K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,110 |
575 |
$55K |
| D2335 |
|
544 |
259 |
$37K |
| D0330 |
Panoramic radiographic image |
854 |
813 |
$29K |
| D2332 |
|
433 |
248 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,075 |
1,028 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
586 |
325 |
$21K |
| D1110 |
Prophylaxis - adult |
568 |
544 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
310 |
227 |
$17K |
| D2331 |
|
298 |
191 |
$15K |
| D2330 |
|
321 |
194 |
$13K |
| D0274 |
Bitewings - four radiographic images |
443 |
425 |
$10K |
| D9110 |
|
488 |
425 |
$9K |
| D2394 |
|
92 |
69 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
541 |
482 |
$4K |
| D1120 |
Prophylaxis - child |
63 |
58 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
56 |
51 |
$675.00 |
| D0272 |
Bitewings - two radiographic images |
26 |
26 |
$381.08 |