| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,545 |
1,301 |
$126K |
| D2335 |
|
1,462 |
558 |
$104K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,592 |
945 |
$91K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,928 |
904 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,927 |
2,758 |
$68K |
| D0330 |
Panoramic radiographic image |
1,909 |
1,798 |
$61K |
| D1110 |
Prophylaxis - adult |
1,528 |
1,432 |
$57K |
| D2394 |
|
755 |
435 |
$51K |
| D0274 |
Bitewings - four radiographic images |
1,250 |
1,179 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
704 |
388 |
$24K |
| D2332 |
|
341 |
198 |
$21K |
| D1120 |
Prophylaxis - child |
339 |
312 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
969 |
907 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
205 |
94 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,778 |
1,593 |
$10K |
| D0272 |
Bitewings - two radiographic images |
430 |
410 |
$6K |
| D2330 |
|
57 |
36 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
407 |
254 |
$2K |
| D2331 |
|
29 |
28 |
$2K |