| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
340 |
216 |
$19K |
| D1110 |
Prophylaxis - adult |
497 |
488 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
192 |
131 |
$10K |
| D0330 |
Panoramic radiographic image |
274 |
270 |
$9K |
| D0274 |
Bitewings - four radiographic images |
379 |
372 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
311 |
306 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
423 |
414 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
147 |
99 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
206 |
200 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
90 |
43 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
135 |
58 |
$5K |
| D1120 |
Prophylaxis - child |
97 |
96 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
245 |
241 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
50 |
49 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
351 |
338 |
$3K |
| D4341 |
|
28 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
318 |
165 |
$2K |
| D2335 |
|
20 |
12 |
$1K |
| D1206 |
Topical application of fluoride varnish |
47 |
47 |
$681.75 |