| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
731 |
404 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
522 |
520 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
417 |
416 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
230 |
128 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,032 |
768 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
131 |
93 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
813 |
790 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
179 |
179 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
100 |
53 |
$6K |
| D0270 |
|
252 |
251 |
$2K |
| D1120 |
Prophylaxis - child |
66 |
66 |
$2K |
| D1110 |
Prophylaxis - adult |
31 |
31 |
$1K |
| D0274 |
Bitewings - four radiographic images |
42 |
38 |
$955.56 |
| D1208 |
Topical application of fluoride, excluding varnish |
41 |
41 |
$713.67 |