| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,330 |
1,233 |
$167K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,855 |
3,848 |
$130K |
| D0274 |
Bitewings - four radiographic images |
2,382 |
2,380 |
$66K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,665 |
3,661 |
$66K |
| D4346 |
|
535 |
533 |
$63K |
| D1110 |
Prophylaxis - adult |
1,219 |
1,217 |
$54K |
| D1120 |
Prophylaxis - child |
1,663 |
1,663 |
$52K |
| D0210 |
Intraoral - complete series of radiographic images |
737 |
723 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
3,104 |
3,065 |
$34K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
364 |
262 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
479 |
162 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,080 |
2,242 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
383 |
222 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
399 |
388 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
405 |
405 |
$9K |
| D0330 |
Panoramic radiographic image |
128 |
128 |
$6K |
| D4341 |
|
33 |
13 |
$4K |
| D9110 |
|
12 |
12 |
$668.25 |
| D9995 |
|
20 |
20 |
$593.02 |