| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
933 |
547 |
$80K |
| D0210 |
Intraoral - complete series of radiographic images |
653 |
653 |
$72K |
| D1110 |
Prophylaxis - adult |
990 |
990 |
$45K |
| D7140 |
Extraction, erupted tooth or exposed root |
713 |
263 |
$40K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
618 |
404 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,342 |
1,341 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
481 |
480 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
32 |
27 |
$6K |
| D4341 |
|
98 |
41 |
$6K |
| D0330 |
Panoramic radiographic image |
783 |
783 |
$5K |
| D0274 |
Bitewings - four radiographic images |
1,251 |
1,251 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
475 |
473 |
$82.98 |
| D1206 |
Topical application of fluoride varnish |
42 |
42 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
538 |
538 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
49 |
42 |
$0.00 |