| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,380 |
740 |
$83K |
| D7140 |
Extraction, erupted tooth or exposed root |
970 |
306 |
$68K |
| D1110 |
Prophylaxis - adult |
1,609 |
1,590 |
$56K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
735 |
475 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,305 |
1,273 |
$35K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
469 |
351 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
1,197 |
1,189 |
$24K |
| D0330 |
Panoramic radiographic image |
680 |
647 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
857 |
822 |
$17K |
| D2331 |
|
69 |
49 |
$4K |
| D2330 |
|
61 |
38 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
378 |
370 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
39 |
38 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$360.00 |