| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,143 |
1,024 |
$214K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
813 |
502 |
$100K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,275 |
626 |
$96K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,466 |
486 |
$92K |
| D0330 |
Panoramic radiographic image |
1,575 |
1,454 |
$87K |
| D1110 |
Prophylaxis - adult |
2,212 |
2,102 |
$83K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,722 |
1,621 |
$71K |
| D0274 |
Bitewings - four radiographic images |
2,114 |
1,975 |
$65K |
| D0220 |
Intraoral - periapical first radiographic image |
2,962 |
2,738 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,652 |
2,309 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
1,612 |
1,514 |
$38K |
| D2330 |
|
601 |
241 |
$37K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
333 |
195 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,117 |
1,047 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
501 |
453 |
$16K |
| D1120 |
Prophylaxis - child |
241 |
227 |
$6K |
| D2394 |
|
36 |
26 |
$6K |
| D4355 |
|
39 |
38 |
$3K |
| D0272 |
Bitewings - two radiographic images |
54 |
50 |
$967.50 |