| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2335 |
|
720 |
268 |
$109K |
| D0330 |
Panoramic radiographic image |
1,389 |
1,252 |
$71K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
672 |
410 |
$66K |
| D1110 |
Prophylaxis - adult |
1,177 |
1,077 |
$61K |
| D2394 |
|
423 |
244 |
$52K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
590 |
358 |
$49K |
| D0140 |
Limited oral evaluation - problem focused |
990 |
897 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
930 |
829 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
1,079 |
753 |
$20K |
| D0274 |
Bitewings - four radiographic images |
701 |
605 |
$17K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
88 |
16 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
474 |
440 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
156 |
99 |
$9K |
| D0160 |
|
148 |
133 |
$8K |
| D4346 |
|
31 |
26 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
793 |
639 |
$4K |
| D1206 |
Topical application of fluoride varnish |
218 |
205 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
622 |
223 |
$1K |
| D0350 |
|
34 |
33 |
$0.00 |
| D3110 |
|
57 |
30 |
$0.00 |