| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
1,009 |
926 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,309 |
1,194 |
$28K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
392 |
315 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
628 |
417 |
$21K |
| D1110 |
Prophylaxis - adult |
427 |
396 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
157 |
132 |
$9K |
| D2332 |
|
107 |
85 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
133 |
108 |
$6K |
| D2335 |
|
61 |
44 |
$4K |
| D9110 |
|
122 |
112 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
94 |
93 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
150 |
139 |
$1K |
| D1120 |
Prophylaxis - child |
26 |
25 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
14 |
12 |
$649.02 |