| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,029 |
492 |
$84K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
663 |
314 |
$67K |
| D7140 |
Extraction, erupted tooth or exposed root |
553 |
222 |
$48K |
| D0210 |
Intraoral - complete series of radiographic images |
547 |
523 |
$45K |
| D1110 |
Prophylaxis - adult |
797 |
781 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,050 |
1,018 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
788 |
712 |
$27K |
| D2394 |
|
169 |
105 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
233 |
143 |
$18K |
| D0274 |
Bitewings - four radiographic images |
472 |
466 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,388 |
623 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
381 |
376 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,122 |
987 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
203 |
201 |
$7K |
| D2331 |
|
49 |
26 |
$6K |
| D1120 |
Prophylaxis - child |
123 |
121 |
$4K |
| D1320 |
|
154 |
151 |
$3K |
| D0330 |
Panoramic radiographic image |
34 |
34 |
$2K |
| D0240 |
|
24 |
13 |
$595.32 |