| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
777 |
447 |
$34K |
| D1110 |
Prophylaxis - adult |
992 |
927 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
819 |
411 |
$27K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
433 |
297 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,072 |
974 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,058 |
1,910 |
$24K |
| D0210 |
Intraoral - complete series of radiographic images |
861 |
794 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
1,117 |
1,073 |
$22K |
| D4341 |
|
796 |
275 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,527 |
1,116 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,484 |
1,381 |
$9K |
| D0274 |
Bitewings - four radiographic images |
998 |
943 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
489 |
451 |
$8K |
| D2331 |
|
116 |
66 |
$6K |
| D4910 |
|
25 |
25 |
$1K |
| D9110 |
|
37 |
26 |
$952.20 |
| D7140 |
Extraction, erupted tooth or exposed root |
29 |
24 |
$819.90 |
| D2330 |
|
18 |
14 |
$569.93 |
| D1120 |
Prophylaxis - child |
15 |
14 |
$298.74 |