| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
968 |
470 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,467 |
1,427 |
$38K |
| D0210 |
Intraoral - complete series of radiographic images |
771 |
694 |
$36K |
| D1110 |
Prophylaxis - adult |
897 |
871 |
$30K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
296 |
174 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
185 |
111 |
$9K |
| D0274 |
Bitewings - four radiographic images |
392 |
375 |
$7K |
| D0330 |
Panoramic radiographic image |
171 |
164 |
$6K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
15 |
15 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
55 |
12 |
$3K |
| D1206 |
Topical application of fluoride varnish |
198 |
195 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
126 |
118 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
151 |
145 |
$2K |
| D1120 |
Prophylaxis - child |
117 |
117 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
415 |
395 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
26 |
13 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
250 |
127 |
$1K |
| D2950 |
|
15 |
14 |
$918.48 |