| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
975 |
582 |
$82K |
| D1110 |
Prophylaxis - adult |
1,875 |
1,845 |
$65K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
705 |
405 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,339 |
1,316 |
$36K |
| D0274 |
Bitewings - four radiographic images |
2,193 |
2,157 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
3,321 |
3,225 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
1,239 |
1,228 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
766 |
752 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,203 |
2,556 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
158 |
89 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
73 |
58 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
149 |
89 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
211 |
211 |
$4K |
| D4341 |
|
29 |
13 |
$2K |
| D1120 |
Prophylaxis - child |
25 |
25 |
$978.11 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$538.77 |