| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
493 |
277 |
$38K |
| D1110 |
Prophylaxis - adult |
822 |
811 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
519 |
512 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
954 |
943 |
$21K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
230 |
129 |
$19K |
| D4355 |
|
358 |
356 |
$17K |
| D1120 |
Prophylaxis - child |
415 |
415 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
396 |
153 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
573 |
565 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
509 |
509 |
$12K |
| D0274 |
Bitewings - four radiographic images |
489 |
485 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
218 |
127 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
375 |
365 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
485 |
459 |
$4K |
| D0272 |
Bitewings - two radiographic images |
48 |
48 |
$1K |
| D0330 |
Panoramic radiographic image |
39 |
39 |
$983.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
168 |
121 |
$858.73 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
20 |
15 |
$768.05 |