| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2394 |
|
1,931 |
655 |
$283K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,987 |
637 |
$246K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,348 |
575 |
$136K |
| D0140 |
Limited oral evaluation - problem focused |
3,494 |
3,294 |
$121K |
| D0330 |
Panoramic radiographic image |
1,611 |
1,566 |
$94K |
| D1110 |
Prophylaxis - adult |
2,179 |
2,128 |
$77K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,682 |
1,631 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
1,926 |
1,877 |
$46K |
| D0274 |
Bitewings - four radiographic images |
1,146 |
1,106 |
$36K |
| D5110 |
|
30 |
30 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
967 |
941 |
$15K |
| D5120 |
|
12 |
12 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
84 |
56 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
36 |
24 |
$4K |
| D0272 |
Bitewings - two radiographic images |
169 |
169 |
$3K |
| D1120 |
Prophylaxis - child |
115 |
115 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
33 |
24 |
$425.85 |