| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,704 |
1,004 |
$146K |
| D0140 |
Limited oral evaluation - problem focused |
3,344 |
3,146 |
$89K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
757 |
296 |
$53K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
447 |
238 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,148 |
1,979 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
2,508 |
2,392 |
$28K |
| D0274 |
Bitewings - four radiographic images |
812 |
794 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
1,016 |
995 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,216 |
1,169 |
$23K |
| D1110 |
Prophylaxis - adult |
715 |
686 |
$23K |
| D2330 |
|
407 |
194 |
$21K |
| D0272 |
Bitewings - two radiographic images |
755 |
723 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
225 |
89 |
$14K |
| D1120 |
Prophylaxis - child |
212 |
208 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
65 |
41 |
$6K |
| D2331 |
|
59 |
40 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
27 |
27 |
$1K |
| D2140 |
|
19 |
12 |
$938.60 |
| D9310 |
|
13 |
13 |
$261.12 |