| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
547 |
289 |
$75K |
| D7140 |
Extraction, erupted tooth or exposed root |
564 |
183 |
$56K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
223 |
151 |
$37K |
| D0210 |
Intraoral - complete series of radiographic images |
360 |
354 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
483 |
475 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
401 |
393 |
$13K |
| D1110 |
Prophylaxis - adult |
217 |
214 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
46 |
33 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
537 |
522 |
$6K |
| D0274 |
Bitewings - four radiographic images |
217 |
215 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
254 |
253 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
140 |
136 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
12 |
$2K |
| D0270 |
|
85 |
85 |
$1K |