| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
649 |
367 |
$47K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
484 |
341 |
$39K |
| D1110 |
Prophylaxis - adult |
736 |
687 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
559 |
462 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
600 |
554 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
178 |
147 |
$17K |
| D2332 |
|
117 |
76 |
$14K |
| D0330 |
Panoramic radiographic image |
257 |
245 |
$9K |
| D2335 |
|
48 |
43 |
$8K |
| D9630 |
|
337 |
320 |
$6K |
| D2950 |
|
78 |
65 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
234 |
229 |
$5K |
| D0274 |
Bitewings - four radiographic images |
177 |
171 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
295 |
287 |
$5K |
| D2330 |
|
50 |
34 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
362 |
350 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
170 |
167 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
183 |
102 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
29 |
14 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
19 |
14 |
$2K |
| D2331 |
|
20 |
15 |
$2K |
| D4342 |
|
27 |
12 |
$2K |
| D1120 |
Prophylaxis - child |
35 |
35 |
$1K |
| D9994 |
|
145 |
145 |
$0.00 |