| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
988 |
521 |
$74K |
| D1110 |
Prophylaxis - adult |
871 |
831 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
1,067 |
1,036 |
$35K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
323 |
199 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
598 |
561 |
$23K |
| D0330 |
Panoramic radiographic image |
537 |
505 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,700 |
1,602 |
$17K |
| D1206 |
Topical application of fluoride varnish |
823 |
796 |
$17K |
| D0274 |
Bitewings - four radiographic images |
1,144 |
1,095 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
272 |
184 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
443 |
422 |
$14K |
| D2331 |
|
138 |
79 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
83 |
32 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,441 |
1,348 |
$3K |
| D1120 |
Prophylaxis - child |
69 |
67 |
$2K |
| D4341 |
|
34 |
12 |
$1K |
| D2332 |
|
14 |
12 |
$1K |
| D4910 |
|
26 |
25 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
14 |
$669.76 |