| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,498 |
846 |
$93K |
| D4341 |
|
548 |
292 |
$78K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,611 |
898 |
$71K |
| D7140 |
Extraction, erupted tooth or exposed root |
921 |
452 |
$57K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
682 |
541 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,443 |
1,438 |
$37K |
| D0330 |
Panoramic radiographic image |
1,373 |
1,366 |
$34K |
| D1120 |
Prophylaxis - child |
781 |
780 |
$33K |
| D1110 |
Prophylaxis - adult |
695 |
694 |
$33K |
| D1351 |
Sealant - per tooth |
538 |
187 |
$28K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
326 |
251 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
879 |
879 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
731 |
730 |
$19K |
| D0274 |
Bitewings - four radiographic images |
1,178 |
1,171 |
$15K |
| D2331 |
|
84 |
50 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
482 |
481 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
373 |
368 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
2,020 |
1,429 |
$5K |
| D2330 |
|
70 |
44 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
256 |
248 |
$725.83 |
| D0272 |
Bitewings - two radiographic images |
47 |
47 |
$424.08 |