| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
209 |
107 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
349 |
345 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
98 |
97 |
$5K |
| D0274 |
Bitewings - four radiographic images |
163 |
163 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
369 |
362 |
$4K |
| D1110 |
Prophylaxis - adult |
79 |
79 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
25 |
14 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
202 |
174 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
15 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
25 |
14 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
51 |
51 |
$834.19 |
| D0140 |
Limited oral evaluation - problem focused |
29 |
29 |
$661.09 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$218.38 |