| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
167 |
60 |
$12K |
| D1110 |
Prophylaxis - adult |
464 |
429 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
117 |
59 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
417 |
379 |
$6K |
| D0274 |
Bitewings - four radiographic images |
596 |
549 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
252 |
230 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,064 |
651 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
834 |
762 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
185 |
169 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
22 |
14 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
25 |
14 |
$1K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
48 |
29 |
$1K |
| D1999 |
|
297 |
265 |
$0.00 |