| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
611 |
339 |
$58K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
481 |
251 |
$47K |
| D1110 |
Prophylaxis - adult |
1,190 |
1,165 |
$43K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
342 |
218 |
$40K |
| D4355 |
|
506 |
485 |
$32K |
| D0330 |
Panoramic radiographic image |
583 |
557 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
1,319 |
1,291 |
$30K |
| D0274 |
Bitewings - four radiographic images |
899 |
862 |
$27K |
| D4341 |
|
287 |
117 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,999 |
1,090 |
$22K |
| D2394 |
|
163 |
89 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,392 |
1,323 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
585 |
546 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
480 |
454 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
141 |
99 |
$10K |
| D1206 |
Topical application of fluoride varnish |
655 |
645 |
$10K |
| D1120 |
Prophylaxis - child |
115 |
113 |
$3K |
| D0272 |
Bitewings - two radiographic images |
18 |
17 |
$299.03 |