| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,926 |
1,170 |
$174K |
| D1110 |
Prophylaxis - adult |
2,491 |
2,491 |
$122K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,421 |
2,421 |
$98K |
| D0330 |
Panoramic radiographic image |
2,164 |
2,163 |
$89K |
| D0274 |
Bitewings - four radiographic images |
2,793 |
2,793 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
2,947 |
2,947 |
$68K |
| D1120 |
Prophylaxis - child |
1,802 |
1,802 |
$63K |
| D0220 |
Intraoral - periapical first radiographic image |
5,179 |
5,082 |
$63K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,263 |
2,263 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
993 |
988 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,001 |
3,912 |
$36K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
465 |
295 |
$33K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
213 |
149 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
213 |
120 |
$17K |
| D0272 |
Bitewings - two radiographic images |
674 |
674 |
$13K |
| D1206 |
Topical application of fluoride varnish |
624 |
624 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
33 |
25 |
$5K |