| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
327 |
193 |
$27K |
| D1110 |
Prophylaxis - adult |
638 |
628 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
675 |
662 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
220 |
89 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
446 |
392 |
$16K |
| D9630 |
|
1,042 |
1,026 |
$12K |
| D1206 |
Topical application of fluoride varnish |
1,040 |
1,027 |
$12K |
| D1120 |
Prophylaxis - child |
676 |
668 |
$11K |
| D0274 |
Bitewings - four radiographic images |
369 |
363 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
754 |
742 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
191 |
188 |
$5K |
| D0330 |
Panoramic radiographic image |
59 |
59 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
73 |
42 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
167 |
164 |
$2K |
| D0272 |
Bitewings - two radiographic images |
132 |
127 |
$1K |