| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
909 |
381 |
$90K |
| D4355 |
|
805 |
744 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,175 |
1,063 |
$47K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
555 |
268 |
$41K |
| D0330 |
Panoramic radiographic image |
743 |
687 |
$38K |
| D0274 |
Bitewings - four radiographic images |
1,100 |
1,017 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
1,271 |
1,157 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,312 |
1,062 |
$14K |
| D1110 |
Prophylaxis - adult |
378 |
350 |
$13K |
| D4341 |
|
157 |
46 |
$11K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
67 |
40 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
439 |
400 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
39 |
26 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
88 |
86 |
$2K |
| D1120 |
Prophylaxis - child |
89 |
69 |
$2K |
| D4346 |
|
41 |
41 |
$2K |
| D1206 |
Topical application of fluoride varnish |
73 |
58 |
$946.79 |
| D1330 |
|
41 |
37 |
$0.00 |
| D1310 |
|
41 |
37 |
$0.00 |