| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,454 |
736 |
$97K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,082 |
498 |
$67K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
487 |
305 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,251 |
1,140 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,412 |
1,309 |
$24K |
| D0330 |
Panoramic radiographic image |
426 |
388 |
$20K |
| D1110 |
Prophylaxis - adult |
516 |
499 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
205 |
66 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
488 |
410 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,666 |
1,581 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
375 |
350 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,473 |
1,319 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
393 |
368 |
$7K |
| D1120 |
Prophylaxis - child |
206 |
191 |
$5K |
| D0240 |
|
260 |
141 |
$4K |
| D2331 |
|
27 |
12 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
39 |
39 |
$748.53 |