| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
534 |
330 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
707 |
685 |
$26K |
| D0274 |
Bitewings - four radiographic images |
880 |
872 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
380 |
107 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
704 |
691 |
$16K |
| D0330 |
Panoramic radiographic image |
517 |
506 |
$15K |
| D1110 |
Prophylaxis - adult |
568 |
556 |
$15K |
| D1206 |
Topical application of fluoride varnish |
1,103 |
1,078 |
$14K |
| D1120 |
Prophylaxis - child |
694 |
675 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
216 |
136 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
77 |
60 |
$7K |
| D0350 |
|
356 |
353 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
611 |
588 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
214 |
208 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
451 |
333 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
100 |
100 |
$3K |
| D0272 |
Bitewings - two radiographic images |
77 |
74 |
$1K |