| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,914 |
737 |
$323K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
849 |
369 |
$113K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,202 |
1,177 |
$66K |
| D7140 |
Extraction, erupted tooth or exposed root |
608 |
192 |
$65K |
| D0140 |
Limited oral evaluation - problem focused |
1,259 |
1,156 |
$58K |
| D1110 |
Prophylaxis - adult |
881 |
859 |
$57K |
| D1206 |
Topical application of fluoride varnish |
1,463 |
1,432 |
$37K |
| D7510 |
|
587 |
424 |
$28K |
| D0330 |
Panoramic radiographic image |
606 |
600 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
827 |
814 |
$26K |
| D0274 |
Bitewings - four radiographic images |
1,005 |
985 |
$24K |
| D1120 |
Prophylaxis - child |
356 |
348 |
$16K |
| D7230 |
|
70 |
54 |
$16K |
| D2335 |
|
76 |
43 |
$13K |
| D7240 |
Removal of impacted tooth - completely bony |
19 |
15 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
44 |
27 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
205 |
199 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
222 |
214 |
$2K |
| D4355 |
|
16 |
14 |
$1K |
| D0272 |
Bitewings - two radiographic images |
17 |
13 |
$246.30 |