| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,460 |
1,273 |
$349K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,814 |
1,035 |
$215K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,206 |
586 |
$123K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,785 |
2,570 |
$112K |
| D0330 |
Panoramic radiographic image |
2,161 |
1,994 |
$109K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
602 |
319 |
$75K |
| D1110 |
Prophylaxis - adult |
1,884 |
1,767 |
$67K |
| D0274 |
Bitewings - four radiographic images |
2,202 |
2,046 |
$64K |
| D7250 |
|
499 |
208 |
$58K |
| D4341 |
|
485 |
194 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
2,699 |
2,479 |
$38K |
| D2332 |
|
406 |
234 |
$38K |
| D7140 |
Extraction, erupted tooth or exposed root |
577 |
177 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,418 |
2,189 |
$28K |
| D5211 |
|
63 |
55 |
$25K |
| D5212 |
|
51 |
44 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
711 |
674 |
$17K |
| D2330 |
|
199 |
106 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
768 |
725 |
$12K |
| D1120 |
Prophylaxis - child |
426 |
407 |
$11K |
| D2335 |
|
59 |
38 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
173 |
154 |
$5K |
| D0272 |
Bitewings - two radiographic images |
179 |
172 |
$3K |
| D4342 |
|
46 |
25 |
$2K |
| D2394 |
|
13 |
12 |
$2K |
| D9110 |
|
43 |
39 |
$2K |
| D4346 |
|
12 |
12 |
$429.96 |