| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,590 |
2,105 |
$251K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,501 |
1,211 |
$243K |
| D0330 |
Panoramic radiographic image |
5,481 |
5,132 |
$213K |
| D1110 |
Prophylaxis - adult |
4,143 |
3,858 |
$167K |
| D0274 |
Bitewings - four radiographic images |
5,723 |
5,351 |
$122K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,965 |
1,112 |
$117K |
| D0140 |
Limited oral evaluation - problem focused |
3,750 |
3,472 |
$115K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,594 |
3,340 |
$95K |
| D1120 |
Prophylaxis - child |
1,716 |
1,617 |
$79K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,815 |
908 |
$62K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,614 |
598 |
$57K |
| D2335 |
|
758 |
319 |
$53K |
| D2394 |
|
682 |
417 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,984 |
2,822 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
2,174 |
2,041 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
7,610 |
6,854 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,809 |
6,040 |
$35K |
| D2332 |
|
204 |
123 |
$13K |
| D4341 |
|
74 |
26 |
$5K |
| D1351 |
Sealant - per tooth |
198 |
44 |
$4K |
| D3310 |
|
27 |
12 |
$4K |
| D7310 |
|
54 |
24 |
$3K |
| D0272 |
Bitewings - two radiographic images |
145 |
144 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
148 |
47 |
$611.65 |
| D2330 |
|
14 |
12 |
$598.40 |
| D0431 |
|
420 |
307 |
$530.00 |
| D9110 |
|
15 |
12 |
$244.80 |
| D9986 |
|
140 |
82 |
$0.00 |