| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
670 |
290 |
$91K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
416 |
211 |
$42K |
| D1120 |
Prophylaxis - child |
371 |
363 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,029 |
979 |
$17K |
| D0330 |
Panoramic radiographic image |
346 |
332 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
620 |
603 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
542 |
530 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
293 |
273 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
324 |
313 |
$13K |
| D1110 |
Prophylaxis - adult |
298 |
288 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,032 |
854 |
$12K |
| D0274 |
Bitewings - four radiographic images |
523 |
509 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
229 |
192 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
40 |
24 |
$4K |
| D0272 |
Bitewings - two radiographic images |
150 |
145 |
$4K |
| D1999 |
|
57 |
47 |
$0.00 |