| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,078 |
1,297 |
$151K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,149 |
943 |
$142K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,629 |
3,629 |
$126K |
| D1110 |
Prophylaxis - adult |
1,979 |
1,976 |
$89K |
| D0210 |
Intraoral - complete series of radiographic images |
1,318 |
1,305 |
$72K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,196 |
723 |
$65K |
| D0274 |
Bitewings - four radiographic images |
1,816 |
1,811 |
$53K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
540 |
382 |
$46K |
| D0140 |
Limited oral evaluation - problem focused |
1,325 |
1,313 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
1,730 |
1,705 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,051 |
1,049 |
$19K |
| D4341 |
|
70 |
30 |
$9K |
| D0330 |
Panoramic radiographic image |
173 |
173 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
269 |
203 |
$2K |
| D4346 |
|
14 |
14 |
$2K |
| D2330 |
|
23 |
14 |
$2K |
| D1120 |
Prophylaxis - child |
45 |
45 |
$1K |
| D9110 |
|
13 |
13 |
$701.47 |
| D0272 |
Bitewings - two radiographic images |
24 |
24 |
$479.21 |