| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,817 |
821 |
$106K |
| D1110 |
Prophylaxis - adult |
2,130 |
1,995 |
$83K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,854 |
1,698 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
2,254 |
2,144 |
$55K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,211 |
3,009 |
$50K |
| D0220 |
Intraoral - periapical first radiographic image |
4,197 |
3,813 |
$35K |
| D0274 |
Bitewings - four radiographic images |
2,650 |
2,478 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
1,200 |
1,067 |
$26K |
| D4341 |
|
799 |
269 |
$25K |
| D1120 |
Prophylaxis - child |
1,042 |
972 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
310 |
152 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
124 |
68 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,649 |
3,578 |
$9K |
| D1999 |
|
610 |
496 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
45 |
28 |
$2K |
| D0272 |
Bitewings - two radiographic images |
223 |
205 |
$2K |