| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
781 |
438 |
$71K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
485 |
272 |
$36K |
| D0330 |
Panoramic radiographic image |
583 |
571 |
$32K |
| D1110 |
Prophylaxis - adult |
644 |
620 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
809 |
792 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
164 |
106 |
$21K |
| D0274 |
Bitewings - four radiographic images |
500 |
485 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
674 |
527 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
245 |
233 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
355 |
341 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
28 |
12 |
$4K |
| D2950 |
|
31 |
27 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
118 |
118 |
$1K |
| D3120 |
|
38 |
24 |
$909.34 |
| D0230 |
Intraoral - periapical each additional radiographic image |
57 |
55 |
$647.27 |
| D1206 |
Topical application of fluoride varnish |
16 |
16 |
$0.00 |