| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
289 |
167 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
890 |
866 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
517 |
398 |
$17K |
| D1120 |
Prophylaxis - child |
372 |
369 |
$16K |
| D1110 |
Prophylaxis - adult |
470 |
454 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
538 |
530 |
$14K |
| D0274 |
Bitewings - four radiographic images |
431 |
420 |
$13K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
88 |
38 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
172 |
167 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
83 |
56 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
149 |
148 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
44 |
28 |
$3K |
| D2331 |
|
21 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
106 |
102 |
$1K |
| D2140 |
|
22 |
16 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
81 |
48 |
$949.62 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
13 |
12 |
$652.08 |