| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
823 |
545 |
$94K |
| D1120 |
Prophylaxis - child |
1,914 |
1,913 |
$74K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
794 |
561 |
$69K |
| D0120 |
Periodic oral evaluation - established patient |
2,281 |
2,278 |
$60K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,098 |
2,097 |
$48K |
| D1110 |
Prophylaxis - adult |
591 |
590 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
190 |
129 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
188 |
188 |
$8K |
| D0272 |
Bitewings - two radiographic images |
299 |
299 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
88 |
87 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
425 |
416 |
$6K |
| D0274 |
Bitewings - four radiographic images |
183 |
182 |
$6K |
| D1351 |
Sealant - per tooth |
238 |
82 |
$6K |
| D1206 |
Topical application of fluoride varnish |
112 |
112 |
$3K |