| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
466 |
247 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
882 |
853 |
$22K |
| D0330 |
Panoramic radiographic image |
445 |
438 |
$19K |
| D1110 |
Prophylaxis - adult |
563 |
545 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
261 |
157 |
$16K |
| D0274 |
Bitewings - four radiographic images |
828 |
803 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
144 |
14 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
439 |
430 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
250 |
224 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
52 |
12 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
443 |
377 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
96 |
94 |
$1K |
| D1120 |
Prophylaxis - child |
51 |
50 |
$940.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
18 |
12 |
$870.57 |
| D0230 |
Intraoral - periapical each additional radiographic image |
99 |
53 |
$465.00 |