| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
823 |
476 |
$54K |
| D0330 |
Panoramic radiographic image |
876 |
867 |
$42K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
429 |
261 |
$34K |
| D7140 |
Extraction, erupted tooth or exposed root |
484 |
296 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
552 |
545 |
$16K |
| D1120 |
Prophylaxis - child |
280 |
280 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
482 |
477 |
$15K |
| D1110 |
Prophylaxis - adult |
265 |
260 |
$13K |
| D0274 |
Bitewings - four radiographic images |
335 |
330 |
$10K |
| D1206 |
Topical application of fluoride varnish |
547 |
540 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
86 |
62 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
101 |
101 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
35 |
24 |
$2K |
| D0272 |
Bitewings - two radiographic images |
113 |
112 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
194 |
189 |
$1K |