| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
674 |
271 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
543 |
257 |
$28K |
| D1120 |
Prophylaxis - child |
963 |
934 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
989 |
959 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
759 |
739 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
451 |
421 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
248 |
248 |
$6K |
| D0274 |
Bitewings - four radiographic images |
297 |
291 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
92 |
53 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
618 |
581 |
$5K |
| D1110 |
Prophylaxis - adult |
179 |
172 |
$4K |
| D0272 |
Bitewings - two radiographic images |
184 |
182 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
31 |
13 |
$1K |
| D0603 |
|
24 |
24 |
$0.00 |