| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2332 |
|
499 |
234 |
$27K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
244 |
142 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
179 |
121 |
$10K |
| D1110 |
Prophylaxis - adult |
286 |
281 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
560 |
538 |
$8K |
| D2331 |
|
128 |
48 |
$7K |
| D5650 |
|
41 |
25 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
244 |
232 |
$2K |
| D2330 |
|
35 |
18 |
$2K |
| D0330 |
Panoramic radiographic image |
45 |
45 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
31 |
24 |
$1K |
| D0274 |
Bitewings - four radiographic images |
42 |
40 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
128 |
80 |
$820.60 |
| D0210 |
Intraoral - complete series of radiographic images |
16 |
16 |
$642.45 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
31 |
30 |
$447.50 |