| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,302 |
1,410 |
$242K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,026 |
803 |
$215K |
| D1110 |
Prophylaxis - adult |
4,581 |
4,375 |
$171K |
| D0330 |
Panoramic radiographic image |
2,422 |
2,296 |
$135K |
| D0120 |
Periodic oral evaluation - established patient |
4,899 |
4,745 |
$122K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,458 |
2,319 |
$102K |
| D0274 |
Bitewings - four radiographic images |
3,195 |
3,042 |
$99K |
| D0140 |
Limited oral evaluation - problem focused |
2,677 |
2,531 |
$92K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
589 |
415 |
$77K |
| D1120 |
Prophylaxis - child |
2,783 |
2,703 |
$75K |
| D1206 |
Topical application of fluoride varnish |
4,605 |
4,471 |
$74K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
756 |
558 |
$60K |
| D0220 |
Intraoral - periapical first radiographic image |
2,083 |
1,945 |
$30K |
| D0272 |
Bitewings - two radiographic images |
1,541 |
1,483 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
97 |
43 |
$7K |
| D1351 |
Sealant - per tooth |
45 |
12 |
$1K |
| D1999 |
|
1,683 |
1,307 |
$0.00 |