| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
936 |
783 |
$136K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
557 |
495 |
$90K |
| D1110 |
Prophylaxis - adult |
1,284 |
1,284 |
$69K |
| D7140 |
Extraction, erupted tooth or exposed root |
391 |
357 |
$49K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
467 |
430 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,505 |
1,505 |
$42K |
| D2394 |
|
151 |
141 |
$26K |
| D2332 |
|
147 |
136 |
$24K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
190 |
181 |
$23K |
| D0274 |
Bitewings - four radiographic images |
722 |
722 |
$19K |
| D0330 |
Panoramic radiographic image |
615 |
615 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
420 |
420 |
$8K |
| D2954 |
|
38 |
37 |
$7K |
| D2335 |
|
28 |
26 |
$6K |
| D1120 |
Prophylaxis - child |
89 |
89 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
207 |
205 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
131 |
131 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
156 |
131 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
115 |
114 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
28 |
28 |
$840.00 |
| D0272 |
Bitewings - two radiographic images |
41 |
41 |
$679.00 |