| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,654 |
1,405 |
$192K |
| D1110 |
Prophylaxis - adult |
4,039 |
3,826 |
$177K |
| D0330 |
Panoramic radiographic image |
3,605 |
3,383 |
$168K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,534 |
4,243 |
$164K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,758 |
691 |
$160K |
| D0210 |
Intraoral - complete series of radiographic images |
6,340 |
3,156 |
$121K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,265 |
794 |
$117K |
| D0140 |
Limited oral evaluation - problem focused |
2,935 |
2,685 |
$99K |
| D0274 |
Bitewings - four radiographic images |
2,485 |
2,340 |
$70K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,235 |
636 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
3,054 |
2,918 |
$64K |
| D2335 |
|
325 |
147 |
$43K |
| D5110 |
|
78 |
71 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
3,299 |
2,945 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,073 |
1,386 |
$25K |
| D2394 |
|
162 |
97 |
$20K |
| D1206 |
Topical application of fluoride varnish |
1,009 |
946 |
$16K |
| D5120 |
|
26 |
25 |
$13K |
| D2332 |
|
130 |
63 |
$13K |
| D2331 |
|
75 |
39 |
$8K |
| D1120 |
Prophylaxis - child |
263 |
238 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
25 |
13 |
$5K |
| D4346 |
|
29 |
25 |
$3K |
| D2330 |
|
41 |
24 |
$2K |
| D1999 |
|
25 |
19 |
$15.00 |