| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,253 |
1,847 |
$124K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,653 |
2,619 |
$101K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,334 |
934 |
$96K |
| D1110 |
Prophylaxis - adult |
1,941 |
1,912 |
$62K |
| D4341 |
|
2,751 |
994 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
1,688 |
1,668 |
$40K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,350 |
1,390 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
3,299 |
2,638 |
$21K |
| D2332 |
|
400 |
254 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
1,842 |
1,813 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,107 |
3,045 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
275 |
212 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,920 |
2,453 |
$7K |
| D2331 |
|
383 |
267 |
$6K |
| D9110 |
|
536 |
514 |
$5K |
| D0330 |
Panoramic radiographic image |
829 |
827 |
$4K |
| D5214 |
|
15 |
15 |
$4K |
| D0274 |
Bitewings - four radiographic images |
1,848 |
1,836 |
$3K |
| D5213 |
|
12 |
12 |
$3K |
| D1330 |
|
3,182 |
3,118 |
$3K |
| D0350 |
|
249 |
249 |
$2K |
| D1120 |
Prophylaxis - child |
235 |
230 |
$2K |
| D2330 |
|
55 |
40 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
2,036 |
2,013 |
$906.88 |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
12 |
$322.72 |
| D1999 |
|
62 |
60 |
$193.35 |
| D3120 |
|
14 |
12 |
$91.00 |
| D5421 |
|
12 |
12 |
$42.18 |
| D5422 |
|
12 |
12 |
$14.06 |
| D9215 |
|
867 |
721 |
$0.00 |