| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
715 |
467 |
$61K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
652 |
211 |
$60K |
| D1110 |
Prophylaxis - adult |
958 |
954 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
647 |
644 |
$27K |
| D0274 |
Bitewings - four radiographic images |
796 |
793 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
271 |
210 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
235 |
235 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
802 |
799 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
467 |
457 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
580 |
579 |
$14K |
| D0330 |
Panoramic radiographic image |
214 |
213 |
$14K |
| D2950 |
|
116 |
104 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
137 |
113 |
$13K |
| D1120 |
Prophylaxis - child |
251 |
250 |
$8K |
| D1351 |
Sealant - per tooth |
122 |
33 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
361 |
356 |
$3K |