| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2394 |
|
757 |
326 |
$121K |
| D0140 |
Limited oral evaluation - problem focused |
2,674 |
2,236 |
$96K |
| D7250 |
|
737 |
188 |
$92K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,073 |
333 |
$70K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
545 |
297 |
$62K |
| D0330 |
Panoramic radiographic image |
1,017 |
1,004 |
$61K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
366 |
194 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,207 |
1,194 |
$39K |
| D1110 |
Prophylaxis - adult |
969 |
965 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
850 |
843 |
$38K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
229 |
140 |
$30K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
226 |
113 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
859 |
826 |
$13K |
| D4355 |
|
171 |
171 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
894 |
531 |
$11K |
| D2332 |
|
82 |
39 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
263 |
262 |
$7K |
| D1206 |
Topical application of fluoride varnish |
247 |
246 |
$4K |
| D1120 |
Prophylaxis - child |
13 |
13 |
$369.98 |