| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
976 |
318 |
$86K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
723 |
270 |
$46K |
| D2394 |
|
400 |
165 |
$38K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
575 |
162 |
$28K |
| D2335 |
|
338 |
115 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
742 |
491 |
$17K |
| D1110 |
Prophylaxis - adult |
699 |
482 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
189 |
84 |
$13K |
| D0274 |
Bitewings - four radiographic images |
716 |
473 |
$12K |
| D0330 |
Panoramic radiographic image |
358 |
246 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,625 |
618 |
$11K |
| D2332 |
|
246 |
77 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
621 |
436 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,054 |
697 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
593 |
405 |
$6K |
| D1120 |
Prophylaxis - child |
370 |
244 |
$6K |
| D2331 |
|
58 |
13 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
74 |
58 |
$2K |
| D0272 |
Bitewings - two radiographic images |
67 |
53 |
$844.32 |