| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,946 |
736 |
$159K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,396 |
1,908 |
$81K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
667 |
377 |
$61K |
| D0330 |
Panoramic radiographic image |
1,626 |
1,321 |
$55K |
| D0274 |
Bitewings - four radiographic images |
2,263 |
1,848 |
$52K |
| D0140 |
Limited oral evaluation - problem focused |
1,615 |
1,336 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
3,830 |
2,974 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,328 |
1,900 |
$43K |
| D1110 |
Prophylaxis - adult |
1,355 |
1,129 |
$41K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
363 |
212 |
$39K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
364 |
188 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
687 |
563 |
$14K |
| D4341 |
|
50 |
13 |
$4K |
| D7250 |
|
27 |
13 |
$3K |
| D7311 |
|
17 |
14 |
$1K |
| D1206 |
Topical application of fluoride varnish |
54 |
51 |
$755.10 |
| D4355 |
|
15 |
12 |
$688.40 |
| D1120 |
Prophylaxis - child |
27 |
26 |
$597.66 |
| D1999 |
|
102 |
59 |
$0.00 |
| D0350 |
|
17 |
13 |
$0.00 |