| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
166 |
97 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
369 |
350 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
232 |
220 |
$15K |
| D1110 |
Prophylaxis - adult |
277 |
262 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
61 |
47 |
$8K |
| D0160 |
|
88 |
84 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
237 |
217 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
95 |
92 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
34 |
27 |
$2K |
| D0330 |
Panoramic radiographic image |
26 |
25 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
28 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
92 |
47 |
$1K |
| D1206 |
Topical application of fluoride varnish |
47 |
44 |
$738.32 |
| D0120 |
Periodic oral evaluation - established patient |
25 |
25 |
$587.04 |
| D0274 |
Bitewings - four radiographic images |
18 |
18 |
$503.25 |