| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
841 |
387 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,407 |
1,337 |
$61K |
| D0210 |
Intraoral - complete series of radiographic images |
795 |
725 |
$56K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
301 |
111 |
$56K |
| D1110 |
Prophylaxis - adult |
626 |
588 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
344 |
197 |
$23K |
| D4346 |
|
152 |
146 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
584 |
557 |
$16K |
| D0274 |
Bitewings - four radiographic images |
418 |
394 |
$15K |
| D1206 |
Topical application of fluoride varnish |
586 |
563 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
835 |
766 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
114 |
61 |
$11K |
| D1120 |
Prophylaxis - child |
287 |
276 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
836 |
628 |
$10K |
| D1351 |
Sealant - per tooth |
322 |
47 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
187 |
164 |
$8K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$787.16 |
| D9986 |
|
177 |
158 |
$0.00 |