| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,708 |
676 |
$84K |
| D1110 |
Prophylaxis - adult |
2,330 |
2,155 |
$52K |
| D0120 |
Periodic oral evaluation - established patient |
1,657 |
1,543 |
$43K |
| D0330 |
Panoramic radiographic image |
1,182 |
1,136 |
$42K |
| D0210 |
Intraoral - complete series of radiographic images |
781 |
735 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,221 |
2,120 |
$19K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
668 |
366 |
$18K |
| D4341 |
|
482 |
167 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
630 |
588 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,256 |
2,981 |
$6K |
| D0274 |
Bitewings - four radiographic images |
3,058 |
2,901 |
$5K |
| D4355 |
|
139 |
136 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
253 |
112 |
$4K |
| D1330 |
|
1,951 |
1,843 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,968 |
1,848 |
$2K |
| D2332 |
|
32 |
13 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
3,875 |
3,630 |
$862.62 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
24 |
14 |
$758.93 |
| D1120 |
Prophylaxis - child |
33 |
32 |
$411.70 |
| D9920 |
|
17 |
17 |
$86.51 |