| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
495 |
294 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
660 |
600 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
256 |
109 |
$9K |
| D0274 |
Bitewings - four radiographic images |
408 |
365 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
196 |
124 |
$8K |
| D1120 |
Prophylaxis - child |
192 |
178 |
$8K |
| D0330 |
Panoramic radiographic image |
232 |
205 |
$7K |
| D1110 |
Prophylaxis - adult |
240 |
206 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
54 |
37 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
94 |
86 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
189 |
169 |
$2K |
| D1351 |
Sealant - per tooth |
51 |
13 |
$929.20 |
| D0220 |
Intraoral - periapical first radiographic image |
108 |
90 |
$705.56 |
| D9110 |
|
31 |
29 |
$669.27 |