| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,794 |
1,071 |
$194K |
| D1110 |
Prophylaxis - adult |
4,151 |
4,071 |
$161K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,302 |
593 |
$137K |
| D0140 |
Limited oral evaluation - problem focused |
3,540 |
3,388 |
$123K |
| D0330 |
Panoramic radiographic image |
2,116 |
2,054 |
$119K |
| D0274 |
Bitewings - four radiographic images |
3,418 |
3,329 |
$109K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,532 |
2,451 |
$106K |
| D0120 |
Periodic oral evaluation - established patient |
3,836 |
3,792 |
$96K |
| D0220 |
Intraoral - periapical first radiographic image |
5,638 |
5,398 |
$85K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,768 |
3,719 |
$77K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
526 |
425 |
$69K |
| D2332 |
|
472 |
304 |
$46K |
| D1206 |
Topical application of fluoride varnish |
2,246 |
2,207 |
$37K |
| D2335 |
|
191 |
133 |
$23K |
| D1120 |
Prophylaxis - child |
783 |
770 |
$22K |
| D4355 |
|
121 |
119 |
$8K |
| D0272 |
Bitewings - two radiographic images |
226 |
218 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
45 |
34 |
$4K |
| D2394 |
|
15 |
12 |
$2K |