| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
387 |
238 |
$52K |
| D1110 |
Prophylaxis - adult |
733 |
732 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
379 |
377 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
1,110 |
1,108 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
641 |
640 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
154 |
111 |
$24K |
| D4342 |
|
226 |
98 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,049 |
1,022 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
377 |
370 |
$13K |
| D0274 |
Bitewings - four radiographic images |
386 |
386 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
32 |
24 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
38 |
12 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
97 |
97 |
$3K |
| D2394 |
|
17 |
13 |
$3K |
| D4910 |
|
40 |
40 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22 |
13 |
$2K |