| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,673 |
744 |
$135K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,267 |
647 |
$98K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,046 |
415 |
$67K |
| D1110 |
Prophylaxis - adult |
1,368 |
1,320 |
$44K |
| D0140 |
Limited oral evaluation - problem focused |
1,485 |
1,430 |
$28K |
| D0274 |
Bitewings - four radiographic images |
1,454 |
1,401 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
2,616 |
2,442 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
178 |
102 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
706 |
685 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,622 |
1,947 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
670 |
644 |
$10K |
| D2332 |
|
37 |
14 |
$3K |
| D2330 |
|
45 |
14 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
69 |
43 |
$2K |
| D1999 |
|
910 |
781 |
$0.00 |