| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,276 |
1,856 |
$249K |
| D1110 |
Prophylaxis - adult |
4,553 |
4,423 |
$151K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,867 |
3,053 |
$132K |
| D0274 |
Bitewings - four radiographic images |
4,202 |
4,127 |
$131K |
| D0140 |
Limited oral evaluation - problem focused |
4,339 |
4,085 |
$120K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,115 |
5,029 |
$105K |
| D0120 |
Periodic oral evaluation - established patient |
4,159 |
4,102 |
$101K |
| D1120 |
Prophylaxis - child |
1,866 |
1,847 |
$82K |
| D0210 |
Intraoral - complete series of radiographic images |
904 |
871 |
$44K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
596 |
303 |
$39K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
381 |
238 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
2,882 |
2,768 |
$31K |
| D2954 |
|
114 |
73 |
$15K |
| D7240 |
Removal of impacted tooth - completely bony |
52 |
24 |
$9K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
18 |
12 |
$9K |
| D0330 |
Panoramic radiographic image |
165 |
158 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
54 |
38 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
316 |
199 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
21 |
14 |
$2K |
| D0270 |
|
29 |
27 |
$227.64 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$223.36 |