| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2330 |
|
2,076 |
293 |
$103K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,593 |
269 |
$80K |
| D0140 |
Limited oral evaluation - problem focused |
953 |
346 |
$51K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
820 |
169 |
$49K |
| D1110 |
Prophylaxis - adult |
337 |
337 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
180 |
13 |
$12K |
| D0170 |
|
319 |
319 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
146 |
146 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
1,242 |
812 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,230 |
810 |
$6K |
| D0274 |
Bitewings - four radiographic images |
121 |
121 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
152 |
152 |
$3K |
| D5422 |
|
33 |
32 |
$660.00 |
| D5421 |
|
30 |
29 |
$600.00 |
| D0240 |
|
274 |
148 |
$505.00 |
| D1330 |
|
12 |
12 |
$121.88 |
| D1310 |
|
12 |
12 |
$119.57 |
| D0250 |
|
72 |
54 |
$9.00 |