| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
344 |
244 |
$30K |
| D1110 |
Prophylaxis - adult |
767 |
732 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
888 |
853 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
213 |
137 |
$14K |
| D0330 |
Panoramic radiographic image |
318 |
298 |
$12K |
| D0274 |
Bitewings - four radiographic images |
431 |
411 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
241 |
221 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
567 |
547 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
122 |
62 |
$7K |
| D1120 |
Prophylaxis - child |
263 |
255 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
161 |
155 |
$5K |
| D1351 |
Sealant - per tooth |
129 |
32 |
$3K |
| D2335 |
|
18 |
13 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
143 |
132 |
$2K |
| D0272 |
Bitewings - two radiographic images |
81 |
81 |
$1K |
| D2330 |
|
17 |
13 |
$1K |