| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,387 |
955 |
$115K |
| D1110 |
Prophylaxis - adult |
1,816 |
1,809 |
$88K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,889 |
1,878 |
$78K |
| D0330 |
Panoramic radiographic image |
1,565 |
1,561 |
$56K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
863 |
578 |
$55K |
| D1206 |
Topical application of fluoride varnish |
2,449 |
2,433 |
$48K |
| D0140 |
Limited oral evaluation - problem focused |
1,387 |
1,334 |
$41K |
| D7140 |
Extraction, erupted tooth or exposed root |
564 |
230 |
$33K |
| D0274 |
Bitewings - four radiographic images |
2,309 |
2,304 |
$33K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
265 |
218 |
$32K |
| D4341 |
|
610 |
270 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
877 |
873 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
884 |
872 |
$9K |
| D2331 |
|
85 |
71 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
67 |
38 |
$8K |
| D1999 |
|
467 |
380 |
$6K |
| D2332 |
|
18 |
13 |
$2K |
| D2330 |
|
33 |
25 |
$2K |
| D2394 |
|
14 |
12 |
$2K |
| D1120 |
Prophylaxis - child |
24 |
24 |
$629.63 |