| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
946 |
426 |
$101K |
| D1110 |
Prophylaxis - adult |
1,573 |
1,471 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
2,115 |
1,992 |
$52K |
| D0274 |
Bitewings - four radiographic images |
863 |
800 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,651 |
1,533 |
$24K |
| D1206 |
Topical application of fluoride varnish |
1,440 |
1,345 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
491 |
482 |
$22K |
| D1120 |
Prophylaxis - child |
654 |
641 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,485 |
1,318 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
80 |
51 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
221 |
209 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
378 |
371 |
$6K |
| D0330 |
Panoramic radiographic image |
94 |
93 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
28 |
13 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
36 |
25 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
24 |
24 |
$960.16 |
| D0272 |
Bitewings - two radiographic images |
39 |
37 |
$700.53 |