| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,035 |
303 |
$100K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
810 |
184 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,207 |
1,041 |
$42K |
| D1120 |
Prophylaxis - child |
1,352 |
1,171 |
$33K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
292 |
97 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
648 |
612 |
$23K |
| D1206 |
Topical application of fluoride varnish |
793 |
688 |
$15K |
| D0330 |
Panoramic radiographic image |
273 |
249 |
$12K |
| D0274 |
Bitewings - four radiographic images |
243 |
219 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
465 |
433 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
271 |
268 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
98 |
31 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
69 |
68 |
$844.66 |
| D0272 |
Bitewings - two radiographic images |
64 |
51 |
$783.09 |