| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,765 |
2,420 |
$223K |
| D0330 |
Panoramic radiographic image |
4,392 |
4,326 |
$190K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,219 |
1,424 |
$171K |
| D1110 |
Prophylaxis - adult |
3,258 |
3,205 |
$141K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,055 |
1,586 |
$132K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,856 |
4,788 |
$131K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,222 |
1,519 |
$97K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,172 |
589 |
$94K |
| D5110 |
|
143 |
141 |
$92K |
| D1120 |
Prophylaxis - child |
1,795 |
1,769 |
$88K |
| D2332 |
|
1,068 |
686 |
$72K |
| D2335 |
|
871 |
479 |
$67K |
| D2394 |
|
911 |
678 |
$65K |
| D5120 |
|
108 |
107 |
$64K |
| D0140 |
Limited oral evaluation - problem focused |
1,455 |
1,388 |
$49K |
| D0274 |
Bitewings - four radiographic images |
1,871 |
1,840 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,345 |
2,315 |
$34K |
| D9110 |
|
1,236 |
1,185 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
2,669 |
2,579 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
420 |
414 |
$10K |
| D0272 |
Bitewings - two radiographic images |
110 |
107 |
$2K |
| D2330 |
|
36 |
28 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
110 |
80 |
$786.84 |
| D9986 |
|
338 |
322 |
$0.00 |