| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,428 |
680 |
$156K |
| D1120 |
Prophylaxis - child |
2,295 |
1,979 |
$69K |
| D1110 |
Prophylaxis - adult |
1,523 |
1,394 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
3,223 |
2,891 |
$66K |
| D0274 |
Bitewings - four radiographic images |
1,715 |
1,526 |
$48K |
| D1206 |
Topical application of fluoride varnish |
2,768 |
2,365 |
$43K |
| D9920 |
|
794 |
675 |
$32K |
| D1310 |
|
777 |
661 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
311 |
190 |
$17K |
| D1330 |
|
777 |
660 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
839 |
784 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
157 |
56 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
358 |
317 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
304 |
286 |
$9K |
| D0272 |
Bitewings - two radiographic images |
476 |
421 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
391 |
342 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
36 |
26 |
$5K |
| D0330 |
Panoramic radiographic image |
61 |
55 |
$3K |
| D2331 |
|
23 |
13 |
$2K |
| D0602 |
|
53 |
39 |
$508.56 |
| D0145 |
Oral evaluation for a patient under three years of age |
24 |
15 |
$385.06 |