| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
613 |
451 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
646 |
586 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
683 |
655 |
$15K |
| D1110 |
Prophylaxis - adult |
421 |
407 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
370 |
286 |
$14K |
| D1120 |
Prophylaxis - child |
306 |
292 |
$12K |
| D0330 |
Panoramic radiographic image |
297 |
279 |
$10K |
| D0274 |
Bitewings - four radiographic images |
355 |
345 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
393 |
376 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
429 |
408 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
83 |
39 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
28 |
24 |
$2K |
| D2331 |
|
18 |
12 |
$954.30 |
| D0120 |
Periodic oral evaluation - established patient |
29 |
29 |
$611.75 |
| D0272 |
Bitewings - two radiographic images |
46 |
40 |
$583.72 |
| D9986 |
|
64 |
43 |
$0.00 |