| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
820 |
713 |
$49K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
594 |
217 |
$46K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
326 |
190 |
$42K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
389 |
209 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
733 |
717 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
169 |
106 |
$20K |
| D2950 |
|
169 |
96 |
$19K |
| D1110 |
Prophylaxis - adult |
247 |
247 |
$13K |
| D0330 |
Panoramic radiographic image |
177 |
177 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
310 |
304 |
$8K |
| D2332 |
|
48 |
25 |
$6K |
| D3310 |
|
16 |
12 |
$6K |
| D3320 |
|
13 |
12 |
$6K |
| D2394 |
|
40 |
25 |
$5K |
| D0274 |
Bitewings - four radiographic images |
116 |
115 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
181 |
180 |
$2K |