| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
163 |
79 |
$11K |
| D1110 |
Prophylaxis - adult |
258 |
238 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
207 |
196 |
$4K |
| D0274 |
Bitewings - four radiographic images |
309 |
285 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
40 |
27 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
507 |
464 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
34 |
16 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
113 |
106 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
14 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
431 |
334 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
151 |
140 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
21 |
13 |
$409.60 |