| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
809 |
410 |
$52K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,023 |
378 |
$42K |
| D1110 |
Prophylaxis - adult |
1,193 |
1,120 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
943 |
887 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,420 |
1,349 |
$28K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
322 |
170 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
669 |
642 |
$11K |
| D0330 |
Panoramic radiographic image |
363 |
359 |
$9K |
| D0274 |
Bitewings - four radiographic images |
499 |
488 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
413 |
392 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
70 |
30 |
$3K |
| D1120 |
Prophylaxis - child |
59 |
59 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
437 |
407 |
$2K |
| D2332 |
|
30 |
18 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
75 |
75 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
23 |
15 |
$835.66 |
| D0230 |
Intraoral - periapical each additional radiographic image |
36 |
28 |
$94.07 |