| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
508 |
293 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
967 |
914 |
$42K |
| D1110 |
Prophylaxis - adult |
579 |
569 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
144 |
97 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,542 |
762 |
$19K |
| D0274 |
Bitewings - four radiographic images |
547 |
526 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
193 |
116 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
423 |
386 |
$15K |
| D0330 |
Panoramic radiographic image |
300 |
285 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
976 |
916 |
$14K |
| D1206 |
Topical application of fluoride varnish |
805 |
782 |
$13K |
| D1120 |
Prophylaxis - child |
449 |
427 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
79 |
37 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
277 |
268 |
$7K |
| D4355 |
|
106 |
98 |
$7K |
| D0272 |
Bitewings - two radiographic images |
191 |
185 |
$3K |
| D1351 |
Sealant - per tooth |
69 |
14 |
$1K |