| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
435 |
160 |
$31K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
323 |
152 |
$31K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
230 |
156 |
$27K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
132 |
70 |
$13K |
| D1110 |
Prophylaxis - adult |
364 |
358 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
318 |
275 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
401 |
395 |
$9K |
| D2335 |
|
68 |
38 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
620 |
332 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
447 |
431 |
$6K |
| D0274 |
Bitewings - four radiographic images |
210 |
205 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
160 |
156 |
$6K |
| D2394 |
|
39 |
25 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
72 |
27 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
275 |
269 |
$4K |
| D0330 |
Panoramic radiographic image |
75 |
73 |
$4K |
| D1120 |
Prophylaxis - child |
132 |
129 |
$3K |
| D2332 |
|
23 |
14 |
$2K |
| D7311 |
|
14 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
32 |
30 |
$527.70 |