| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
860 |
538 |
$99K |
| D1120 |
Prophylaxis - child |
1,303 |
1,301 |
$49K |
| D0120 |
Periodic oral evaluation - established patient |
1,423 |
1,422 |
$37K |
| D1110 |
Prophylaxis - adult |
699 |
692 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
580 |
577 |
$24K |
| D0274 |
Bitewings - four radiographic images |
752 |
748 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
248 |
175 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
888 |
887 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,165 |
1,140 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,483 |
835 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
108 |
66 |
$10K |
| D2740 |
Crown - porcelain/ceramic |
16 |
13 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
47 |
29 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
141 |
139 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
30 |
27 |
$5K |
| D0272 |
Bitewings - two radiographic images |
189 |
189 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
46 |
46 |
$3K |
| D2950 |
|
12 |
12 |
$2K |