| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,467 |
828 |
$108K |
| D1110 |
Prophylaxis - adult |
2,115 |
2,114 |
$107K |
| D0330 |
Panoramic radiographic image |
1,353 |
1,353 |
$63K |
| D0274 |
Bitewings - four radiographic images |
1,392 |
1,392 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,326 |
1,326 |
$36K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
745 |
460 |
$35K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
327 |
241 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
1,042 |
1,041 |
$26K |
| D1120 |
Prophylaxis - child |
504 |
504 |
$19K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
122 |
41 |
$10K |
| D1206 |
Topical application of fluoride varnish |
317 |
317 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
520 |
520 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
65 |
32 |
$5K |
| D0272 |
Bitewings - two radiographic images |
208 |
208 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
213 |
213 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
208 |
205 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
35 |
13 |
$2K |
| D2331 |
|
19 |
12 |
$2K |
| D2140 |
|
18 |
12 |
$916.92 |