| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,641 |
2,218 |
$365K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,374 |
1,055 |
$172K |
| D0330 |
Panoramic radiographic image |
3,350 |
3,048 |
$155K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,920 |
1,222 |
$145K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,462 |
3,164 |
$133K |
| D0274 |
Bitewings - four radiographic images |
4,243 |
3,896 |
$122K |
| D0220 |
Intraoral - periapical first radiographic image |
7,479 |
6,735 |
$102K |
| D0140 |
Limited oral evaluation - problem focused |
2,992 |
2,713 |
$96K |
| D1110 |
Prophylaxis - adult |
2,707 |
2,523 |
$93K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,523 |
665 |
$92K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
912 |
553 |
$91K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,515 |
5,068 |
$74K |
| D4355 |
|
1,158 |
1,059 |
$69K |
| D0120 |
Periodic oral evaluation - established patient |
2,512 |
2,335 |
$54K |
| D2335 |
|
269 |
157 |
$32K |
| D2332 |
|
293 |
210 |
$27K |
| D7250 |
|
231 |
128 |
$26K |
| D4341 |
|
240 |
98 |
$20K |
| D2331 |
|
204 |
145 |
$16K |
| D5212 |
|
18 |
17 |
$7K |
| D1206 |
Topical application of fluoride varnish |
674 |
634 |
$6K |
| D2330 |
|
68 |
44 |
$4K |
| D4346 |
|
32 |
30 |
$1K |
| D9110 |
|
13 |
12 |
$477.72 |
| D4910 |
|
124 |
117 |
$0.00 |