| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
697 |
265 |
$39K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
334 |
86 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,350 |
1,264 |
$37K |
| D0330 |
Panoramic radiographic image |
1,175 |
1,104 |
$32K |
| D1110 |
Prophylaxis - adult |
821 |
779 |
$28K |
| D2335 |
|
180 |
57 |
$23K |
| D2332 |
|
190 |
60 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
448 |
154 |
$20K |
| D4341 |
|
687 |
198 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
963 |
910 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
354 |
315 |
$8K |
| D0274 |
Bitewings - four radiographic images |
481 |
463 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
55 |
29 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
537 |
474 |
$4K |
| D1999 |
|
430 |
312 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
167 |
161 |
$3K |
| D7311 |
|
19 |
13 |
$3K |
| D1120 |
Prophylaxis - child |
128 |
119 |
$3K |
| D9110 |
|
38 |
31 |
$2K |
| D2330 |
|
47 |
12 |
$884.58 |
| D0230 |
Intraoral - periapical each additional radiographic image |
223 |
159 |
$818.07 |
| D0603 |
|
14 |
12 |
$0.00 |