| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
451 |
210 |
$62K |
| D4910 |
|
431 |
429 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
730 |
704 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
344 |
335 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,836 |
1,730 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
213 |
99 |
$23K |
| D4342 |
|
231 |
86 |
$22K |
| D0180 |
|
443 |
439 |
$19K |
| D4341 |
|
112 |
46 |
$19K |
| D1206 |
Topical application of fluoride varnish |
654 |
649 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
493 |
490 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
73 |
35 |
$7K |
| D1120 |
Prophylaxis - child |
187 |
183 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
150 |
147 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
32 |
26 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
23 |
13 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
238 |
233 |
$3K |
| D0274 |
Bitewings - four radiographic images |
81 |
80 |
$2K |
| D1110 |
Prophylaxis - adult |
26 |
26 |
$1K |
| D0190 |
|
62 |
60 |
$1K |
| D0272 |
Bitewings - two radiographic images |
15 |
14 |
$316.95 |