| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
868 |
501 |
$64K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
537 |
272 |
$31K |
| D1110 |
Prophylaxis - adult |
824 |
741 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
414 |
375 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
700 |
629 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
571 |
484 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
693 |
660 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,642 |
1,243 |
$17K |
| D0274 |
Bitewings - four radiographic images |
493 |
453 |
$16K |
| D1120 |
Prophylaxis - child |
360 |
342 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
148 |
107 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
527 |
502 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,146 |
756 |
$10K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
15 |
12 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
45 |
24 |
$5K |
| D2954 |
|
19 |
13 |
$3K |
| D0330 |
Panoramic radiographic image |
32 |
27 |
$1K |