| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
130 |
72 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
72 |
44 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
195 |
191 |
$7K |
| D1110 |
Prophylaxis - adult |
183 |
180 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
81 |
80 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
275 |
265 |
$6K |
| D0274 |
Bitewings - four radiographic images |
143 |
141 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
25 |
13 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
297 |
288 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
74 |
71 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
39 |
38 |
$1K |