| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
796 |
429 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
738 |
733 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
371 |
192 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
534 |
523 |
$14K |
| D1110 |
Prophylaxis - adult |
340 |
338 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,236 |
930 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,076 |
1,035 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
191 |
187 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
112 |
55 |
$7K |
| D0274 |
Bitewings - four radiographic images |
217 |
211 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
39 |
13 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
42 |
26 |
$4K |
| D0270 |
|
181 |
180 |
$2K |
| D1120 |
Prophylaxis - child |
31 |
29 |
$919.76 |
| D1208 |
Topical application of fluoride, excluding varnish |
31 |
29 |
$526.39 |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$457.47 |