| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
680 |
404 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
648 |
638 |
$21K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
238 |
167 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
614 |
601 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,382 |
1,016 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
287 |
267 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,099 |
1,062 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
152 |
90 |
$8K |
| D1110 |
Prophylaxis - adult |
126 |
124 |
$5K |
| D0270 |
|
259 |
254 |
$2K |
| D0274 |
Bitewings - four radiographic images |
84 |
84 |
$2K |
| D1120 |
Prophylaxis - child |
51 |
51 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
12 |
12 |
$814.20 |
| D1208 |
Topical application of fluoride, excluding varnish |
40 |
40 |
$730.52 |