| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
413 |
301 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
148 |
64 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
277 |
219 |
$9K |
| D1110 |
Prophylaxis - adult |
224 |
197 |
$6K |
| D7250 |
|
66 |
24 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
63 |
34 |
$4K |
| D1120 |
Prophylaxis - child |
85 |
72 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
57 |
31 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
76 |
30 |
$3K |
| D2332 |
|
36 |
14 |
$2K |
| D1206 |
Topical application of fluoride varnish |
92 |
88 |
$2K |
| D0330 |
Panoramic radiographic image |
213 |
168 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
39 |
13 |
$2K |
| D2140 |
|
41 |
25 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
22 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
162 |
74 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
64 |
56 |
$1K |
| D2330 |
|
30 |
12 |
$1K |
| D0274 |
Bitewings - four radiographic images |
21 |
17 |
$620.16 |
| D1208 |
Topical application of fluoride, excluding varnish |
15 |
15 |
$292.90 |