| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,584 |
1,853 |
$277K |
| D1110 |
Prophylaxis - adult |
5,786 |
5,188 |
$262K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,596 |
806 |
$230K |
| D0330 |
Panoramic radiographic image |
4,437 |
3,836 |
$190K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,239 |
4,657 |
$190K |
| D0274 |
Bitewings - four radiographic images |
5,354 |
4,802 |
$162K |
| D0120 |
Periodic oral evaluation - established patient |
5,217 |
4,680 |
$115K |
| D0140 |
Limited oral evaluation - problem focused |
3,368 |
2,950 |
$107K |
| D0210 |
Intraoral - complete series of radiographic images |
3,721 |
3,245 |
$107K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,092 |
718 |
$105K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,259 |
772 |
$73K |
| D4346 |
|
423 |
371 |
$58K |
| D1206 |
Topical application of fluoride varnish |
2,372 |
2,057 |
$41K |
| D1120 |
Prophylaxis - child |
1,046 |
900 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
282 |
109 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
2,288 |
1,832 |
$18K |
| D2335 |
|
61 |
42 |
$10K |
| D0272 |
Bitewings - two radiographic images |
397 |
335 |
$9K |
| D2949 |
|
67 |
52 |
$7K |
| D2394 |
|
47 |
38 |
$5K |
| D1351 |
Sealant - per tooth |
197 |
26 |
$5K |
| D7250 |
|
25 |
12 |
$4K |
| D4342 |
|
40 |
13 |
$3K |
| D2331 |
|
20 |
13 |
$2K |
| D1999 |
|
579 |
485 |
$178.48 |
| D0350 |
|
1,372 |
1,248 |
$0.00 |