| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,021 |
969 |
$107K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,197 |
867 |
$88K |
| D0330 |
Panoramic radiographic image |
2,253 |
2,103 |
$73K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,143 |
581 |
$69K |
| D1110 |
Prophylaxis - adult |
1,916 |
1,773 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,421 |
2,253 |
$56K |
| D0274 |
Bitewings - four radiographic images |
2,042 |
1,911 |
$41K |
| D7140 |
Extraction, erupted tooth or exposed root |
851 |
258 |
$28K |
| D9110 |
|
1,059 |
953 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
227 |
155 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
909 |
860 |
$12K |
| D2335 |
|
157 |
74 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,980 |
1,790 |
$10K |
| D1120 |
Prophylaxis - child |
92 |
88 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,165 |
555 |
$4K |
| D2332 |
|
34 |
25 |
$2K |
| D2330 |
|
27 |
14 |
$1K |
| D0272 |
Bitewings - two radiographic images |
25 |
24 |
$379.40 |
| D0140 |
Limited oral evaluation - problem focused |
14 |
13 |
$369.60 |