| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2335 |
|
1,293 |
384 |
$161K |
| D2394 |
|
819 |
360 |
$81K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,630 |
584 |
$73K |
| D0210 |
Intraoral - complete series of radiographic images |
1,472 |
1,210 |
$70K |
| D0140 |
Limited oral evaluation - problem focused |
2,024 |
1,688 |
$65K |
| D1110 |
Prophylaxis - adult |
1,475 |
1,288 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,554 |
1,327 |
$49K |
| D0120 |
Periodic oral evaluation - established patient |
1,640 |
1,445 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
388 |
118 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
2,557 |
2,117 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,124 |
861 |
$18K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
177 |
112 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
119 |
38 |
$11K |
| D0274 |
Bitewings - four radiographic images |
228 |
191 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
83 |
43 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
480 |
419 |
$5K |
| D1206 |
Topical application of fluoride varnish |
344 |
290 |
$3K |
| D2332 |
|
23 |
13 |
$2K |
| D1120 |
Prophylaxis - child |
46 |
39 |
$1K |
| D0330 |
Panoramic radiographic image |
28 |
25 |
$771.36 |
| D1999 |
|
14 |
13 |
$10.00 |