| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
535 |
374 |
$25K |
| D1110 |
Prophylaxis - adult |
705 |
657 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
917 |
884 |
$20K |
| D0330 |
Panoramic radiographic image |
631 |
599 |
$20K |
| D1120 |
Prophylaxis - child |
394 |
385 |
$16K |
| D0274 |
Bitewings - four radiographic images |
734 |
711 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
432 |
229 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
216 |
170 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
292 |
194 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
741 |
724 |
$9K |
| D2335 |
|
100 |
53 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
1,180 |
1,102 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,765 |
667 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
248 |
224 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
288 |
267 |
$5K |
| D2332 |
|
60 |
39 |
$3K |
| D2394 |
|
34 |
25 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
15 |
12 |
$732.24 |
| D9110 |
|
14 |
13 |
$280.51 |
| D1999 |
|
97 |
82 |
$0.00 |