| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,283 |
842 |
$95K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,069 |
1,106 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,822 |
1,814 |
$56K |
| D1110 |
Prophylaxis - adult |
2,502 |
2,491 |
$36K |
| D0330 |
Panoramic radiographic image |
1,578 |
1,574 |
$34K |
| D0210 |
Intraoral - complete series of radiographic images |
419 |
417 |
$30K |
| D2332 |
|
664 |
322 |
$28K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
495 |
303 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,066 |
639 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
987 |
982 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,941 |
1,934 |
$8K |
| D0274 |
Bitewings - four radiographic images |
1,776 |
1,771 |
$4K |
| D1330 |
|
2,437 |
2,427 |
$2K |
| D1120 |
Prophylaxis - child |
95 |
94 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
2,038 |
1,968 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
123 |
122 |
$866.28 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,738 |
1,673 |
$700.82 |