| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
768 |
403 |
$106K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
361 |
226 |
$62K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
466 |
249 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
832 |
825 |
$46K |
| D0330 |
Panoramic radiographic image |
749 |
743 |
$34K |
| D2750 |
|
67 |
41 |
$33K |
| D1110 |
Prophylaxis - adult |
303 |
303 |
$20K |
| D0274 |
Bitewings - four radiographic images |
718 |
713 |
$17K |
| D4341 |
|
99 |
40 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
35 |
12 |
$4K |
| D2950 |
|
43 |
28 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
298 |
275 |
$3K |
| D2332 |
|
17 |
12 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
39 |
39 |
$1K |
| D3120 |
|
34 |
26 |
$1K |