| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,710 |
1,055 |
$115K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,455 |
1,771 |
$108K |
| D0330 |
Panoramic radiographic image |
1,930 |
1,886 |
$74K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,421 |
1,109 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
913 |
896 |
$40K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,388 |
811 |
$35K |
| D2332 |
|
705 |
381 |
$32K |
| D1110 |
Prophylaxis - adult |
1,669 |
1,641 |
$24K |
| D4341 |
|
1,055 |
340 |
$19K |
| D2331 |
|
407 |
261 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,223 |
2,176 |
$13K |
| D5214 |
|
29 |
24 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
177 |
169 |
$6K |
| D2330 |
|
119 |
50 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
89 |
57 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,845 |
1,811 |
$4K |
| D5213 |
|
13 |
12 |
$3K |
| D0274 |
Bitewings - four radiographic images |
1,595 |
1,564 |
$2K |
| D1330 |
|
1,851 |
1,818 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
157 |
151 |
$696.54 |
| D0220 |
Intraoral - periapical first radiographic image |
1,891 |
1,842 |
$674.25 |
| D1120 |
Prophylaxis - child |
60 |
59 |
$481.79 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,681 |
1,626 |
$478.59 |
| D3120 |
|
25 |
16 |
$0.00 |