| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
254 |
105 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
870 |
751 |
$25K |
| D1110 |
Prophylaxis - adult |
455 |
411 |
$14K |
| D0330 |
Panoramic radiographic image |
407 |
325 |
$14K |
| D0274 |
Bitewings - four radiographic images |
399 |
327 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,054 |
436 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
209 |
182 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
88 |
53 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
576 |
486 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
199 |
169 |
$4K |
| D4341 |
|
43 |
14 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
26 |
12 |
$3K |
| D4346 |
|
30 |
28 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
36 |
30 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
31 |
28 |
$251.52 |
| D8670 |
Periodic orthodontic treatment visit |
26 |
26 |
$0.00 |