| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
367 |
179 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
652 |
550 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
854 |
723 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
500 |
426 |
$15K |
| D1110 |
Prophylaxis - adult |
432 |
362 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
97 |
56 |
$7K |
| D0330 |
Panoramic radiographic image |
188 |
173 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
36 |
26 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
52 |
18 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
381 |
318 |
$4K |
| D1206 |
Topical application of fluoride varnish |
379 |
318 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
101 |
90 |
$2K |
| D0274 |
Bitewings - four radiographic images |
70 |
64 |
$1K |
| D0270 |
|
50 |
41 |
$328.10 |
| D0230 |
Intraoral - periapical each additional radiographic image |
40 |
27 |
$327.79 |
| D0272 |
Bitewings - two radiographic images |
14 |
13 |
$77.40 |