| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
822 |
459 |
$70K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
922 |
899 |
$43K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
641 |
334 |
$42K |
| D1110 |
Prophylaxis - adult |
713 |
693 |
$42K |
| D0330 |
Panoramic radiographic image |
711 |
691 |
$28K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
226 |
106 |
$26K |
| D4341 |
|
540 |
139 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
204 |
155 |
$24K |
| D1206 |
Topical application of fluoride varnish |
935 |
905 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
484 |
465 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,323 |
1,225 |
$16K |
| D0274 |
Bitewings - four radiographic images |
813 |
790 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
143 |
69 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,614 |
1,025 |
$7K |
| D1351 |
Sealant - per tooth |
85 |
14 |
$2K |
| D2394 |
|
21 |
17 |
$2K |
| D1120 |
Prophylaxis - child |
12 |
12 |
$252.78 |