| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
234 |
167 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
476 |
420 |
$11K |
| D2750 |
|
17 |
12 |
$5K |
| D1120 |
Prophylaxis - child |
154 |
144 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
190 |
166 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
145 |
138 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
29 |
25 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
569 |
496 |
$3K |
| D0274 |
Bitewings - four radiographic images |
217 |
188 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
26 |
14 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
57 |
42 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
146 |
133 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
103 |
93 |
$2K |
| D2950 |
|
20 |
15 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
321 |
275 |
$1K |
| D1110 |
Prophylaxis - adult |
29 |
27 |
$1K |
| D1206 |
Topical application of fluoride varnish |
30 |
30 |
$754.00 |
| D0330 |
Panoramic radiographic image |
30 |
25 |
$504.80 |
| D0270 |
|
12 |
12 |
$67.20 |