| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
995 |
550 |
$55K |
| D7140 |
Extraction, erupted tooth or exposed root |
793 |
389 |
$31K |
| D1110 |
Prophylaxis - adult |
952 |
932 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
720 |
696 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
595 |
308 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
734 |
716 |
$17K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
355 |
239 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
251 |
174 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
755 |
739 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
690 |
658 |
$14K |
| D0274 |
Bitewings - four radiographic images |
535 |
522 |
$10K |
| D4355 |
|
199 |
198 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
855 |
810 |
$6K |
| D1120 |
Prophylaxis - child |
106 |
106 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
528 |
418 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
111 |
111 |
$3K |
| D7250 |
|
45 |
17 |
$3K |
| D0330 |
Panoramic radiographic image |
36 |
35 |
$608.14 |
| D0270 |
|
13 |
13 |
$113.61 |