| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,106 |
708 |
$104K |
| D1110 |
Prophylaxis - adult |
1,638 |
1,633 |
$68K |
| D0140 |
Limited oral evaluation - problem focused |
1,670 |
1,615 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,184 |
1,180 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
2,892 |
2,774 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,363 |
1,357 |
$35K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
312 |
258 |
$33K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
273 |
142 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
884 |
884 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
282 |
191 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,089 |
1,853 |
$16K |
| D1120 |
Prophylaxis - child |
331 |
331 |
$14K |
| D0330 |
Panoramic radiographic image |
166 |
166 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
77 |
55 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
211 |
211 |
$5K |
| D1206 |
Topical application of fluoride varnish |
79 |
79 |
$2K |
| D0270 |
|
57 |
56 |
$743.49 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$326.37 |