| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
359 |
183 |
$16K |
| D1110 |
Prophylaxis - adult |
314 |
291 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
159 |
98 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
380 |
353 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
427 |
384 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
262 |
242 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
200 |
77 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
917 |
818 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
83 |
37 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
217 |
198 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
113 |
107 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
34 |
24 |
$2K |
| D0274 |
Bitewings - four radiographic images |
166 |
154 |
$2K |
| D2335 |
|
21 |
13 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
655 |
313 |
$1K |
| D2394 |
|
20 |
12 |
$982.68 |
| D1206 |
Topical application of fluoride varnish |
26 |
24 |
$285.92 |
| D0270 |
|
35 |
29 |
$167.28 |