| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
957 |
477 |
$43K |
| D0330 |
Panoramic radiographic image |
857 |
675 |
$24K |
| D1110 |
Prophylaxis - adult |
634 |
532 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
842 |
648 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
332 |
192 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
448 |
254 |
$16K |
| D0274 |
Bitewings - four radiographic images |
775 |
656 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
604 |
511 |
$13K |
| D1120 |
Prophylaxis - child |
223 |
211 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
515 |
464 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
380 |
344 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
847 |
674 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
121 |
77 |
$3K |
| D2331 |
|
64 |
39 |
$3K |
| D2335 |
|
25 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
337 |
143 |
$956.15 |
| D0272 |
Bitewings - two radiographic images |
15 |
15 |
$252.98 |