| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4346 |
|
548 |
546 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,439 |
1,430 |
$50K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
546 |
373 |
$38K |
| D0210 |
Intraoral - complete series of radiographic images |
470 |
468 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
368 |
197 |
$24K |
| D0274 |
Bitewings - four radiographic images |
616 |
612 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
167 |
113 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
462 |
460 |
$14K |
| D1110 |
Prophylaxis - adult |
208 |
207 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
659 |
647 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
68 |
40 |
$4K |
| D9110 |
|
19 |
19 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$220.61 |