| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
105 |
58 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
76 |
58 |
$8K |
| D0274 |
Bitewings - four radiographic images |
195 |
187 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
195 |
186 |
$6K |
| D1110 |
Prophylaxis - adult |
158 |
152 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
208 |
205 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
234 |
230 |
$5K |
| D1120 |
Prophylaxis - child |
103 |
100 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
73 |
73 |
$4K |
| D2335 |
|
24 |
13 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
325 |
159 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
224 |
215 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
21 |
12 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
27 |
14 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14 |
14 |
$422.50 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
103 |
59 |
$0.00 |
| D7250 |
|
29 |
14 |
$0.00 |