| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
886 |
531 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,158 |
1,123 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
491 |
479 |
$27K |
| D1110 |
Prophylaxis - adult |
566 |
558 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
689 |
332 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
380 |
281 |
$23K |
| D1120 |
Prophylaxis - child |
336 |
330 |
$19K |
| D0330 |
Panoramic radiographic image |
352 |
345 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
364 |
216 |
$14K |
| D0274 |
Bitewings - four radiographic images |
428 |
417 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
497 |
484 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
395 |
372 |
$11K |
| D1206 |
Topical application of fluoride varnish |
482 |
480 |
$8K |
| D2332 |
|
117 |
73 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
576 |
549 |
$4K |
| D2335 |
|
42 |
27 |
$3K |
| D2331 |
|
43 |
27 |
$2K |
| D2394 |
|
16 |
12 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
80 |
75 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
59 |
25 |
$298.76 |