| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,295 |
1,042 |
$193K |
| D0330 |
Panoramic radiographic image |
4,219 |
3,020 |
$160K |
| D1110 |
Prophylaxis - adult |
3,463 |
3,285 |
$153K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,894 |
2,840 |
$87K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,774 |
465 |
$74K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
634 |
359 |
$72K |
| D9630 |
|
3,330 |
2,727 |
$54K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
683 |
215 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,763 |
1,760 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
1,794 |
1,746 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,617 |
1,537 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
398 |
209 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
1,437 |
913 |
$22K |
| D1120 |
Prophylaxis - child |
660 |
660 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
1,754 |
1,123 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
2,470 |
1,622 |
$18K |
| D1354 |
|
517 |
78 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
698 |
215 |
$4K |
| D4342 |
|
83 |
27 |
$4K |
| D9920 |
|
54 |
50 |
$4K |
| D0272 |
Bitewings - two radiographic images |
15 |
14 |
$282.10 |
| D8670 |
Periodic orthodontic treatment visit |
13 |
13 |
$0.00 |