| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
1,510 |
348 |
$64K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
639 |
378 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
797 |
729 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,550 |
1,441 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
442 |
395 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
687 |
654 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
151 |
108 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
479 |
431 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,330 |
1,228 |
$13K |
| D1110 |
Prophylaxis - adult |
192 |
185 |
$9K |
| D1120 |
Prophylaxis - child |
279 |
263 |
$6K |
| D0274 |
Bitewings - four radiographic images |
457 |
433 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
39 |
26 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
921 |
845 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
25 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
85 |
82 |
$815.50 |
| D0270 |
|
40 |
38 |
$340.80 |