| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,436 |
598 |
$173K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
958 |
416 |
$160K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,264 |
324 |
$154K |
| D0330 |
Panoramic radiographic image |
1,008 |
982 |
$48K |
| D1110 |
Prophylaxis - adult |
875 |
842 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,202 |
1,151 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,197 |
1,152 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
2,022 |
1,960 |
$30K |
| D1206 |
Topical application of fluoride varnish |
1,499 |
1,451 |
$26K |
| D2394 |
|
122 |
60 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,913 |
1,829 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
233 |
89 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
603 |
584 |
$12K |
| D5214 |
|
13 |
13 |
$12K |
| D1120 |
Prophylaxis - child |
244 |
238 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
92 |
91 |
$3K |
| D0272 |
Bitewings - two radiographic images |
15 |
15 |
$274.35 |