| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
739 |
309 |
$56K |
| D0210 |
Intraoral - complete series of radiographic images |
836 |
699 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
928 |
834 |
$34K |
| D1110 |
Prophylaxis - adult |
619 |
552 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
322 |
153 |
$18K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
116 |
51 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
299 |
275 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
111 |
63 |
$9K |
| D1351 |
Sealant - per tooth |
353 |
42 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
408 |
365 |
$9K |
| D1206 |
Topical application of fluoride varnish |
299 |
275 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
354 |
309 |
$4K |
| D0274 |
Bitewings - four radiographic images |
124 |
115 |
$3K |
| D1120 |
Prophylaxis - child |
81 |
75 |
$3K |
| D0330 |
Panoramic radiographic image |
44 |
39 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13 |
12 |
$105.00 |