| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
563 |
270 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
665 |
659 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
148 |
117 |
$10K |
| D1110 |
Prophylaxis - adult |
219 |
216 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
193 |
188 |
$9K |
| D2330 |
|
134 |
57 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
111 |
54 |
$7K |
| D4346 |
|
61 |
60 |
$7K |
| D0330 |
Panoramic radiographic image |
147 |
145 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
220 |
218 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
248 |
247 |
$4K |
| D0274 |
Bitewings - four radiographic images |
151 |
149 |
$4K |
| D1120 |
Prophylaxis - child |
126 |
125 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
23 |
14 |
$3K |
| D2140 |
|
30 |
15 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
147 |
144 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
25 |
25 |
$551.44 |
| D0230 |
Intraoral - periapical each additional radiographic image |
20 |
17 |
$179.90 |