| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
290 |
177 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
340 |
190 |
$36K |
| D2394 |
|
208 |
123 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
359 |
343 |
$25K |
| D2335 |
|
187 |
99 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
630 |
580 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
500 |
480 |
$21K |
| D0330 |
Panoramic radiographic image |
305 |
293 |
$18K |
| D1110 |
Prophylaxis - adult |
409 |
397 |
$16K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
135 |
70 |
$15K |
| D2332 |
|
111 |
68 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
534 |
493 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
82 |
55 |
$7K |
| D4355 |
|
94 |
92 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
440 |
176 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
191 |
186 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
59 |
59 |
$2K |
| D1120 |
Prophylaxis - child |
12 |
12 |
$313.06 |