| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
887 |
493 |
$69K |
| D0210 |
Intraoral - complete series of radiographic images |
1,462 |
1,377 |
$67K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
477 |
166 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,469 |
1,410 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
562 |
277 |
$36K |
| D0274 |
Bitewings - four radiographic images |
840 |
821 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,031 |
997 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
872 |
849 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
548 |
512 |
$17K |
| D1110 |
Prophylaxis - adult |
431 |
413 |
$14K |
| D1120 |
Prophylaxis - child |
256 |
246 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
389 |
366 |
$6K |
| D0330 |
Panoramic radiographic image |
74 |
71 |
$4K |
| D1206 |
Topical application of fluoride varnish |
195 |
188 |
$3K |
| D4346 |
|
31 |
28 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
129 |
117 |
$789.52 |