| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
173 |
88 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
823 |
711 |
$12K |
| D1110 |
Prophylaxis - adult |
187 |
177 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
108 |
44 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,411 |
440 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
194 |
178 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
197 |
190 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
73 |
27 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
279 |
234 |
$5K |
| D0274 |
Bitewings - four radiographic images |
122 |
117 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
147 |
116 |
$3K |
| D1120 |
Prophylaxis - child |
91 |
82 |
$3K |
| D1206 |
Topical application of fluoride varnish |
21 |
21 |
$440.00 |