| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,115 |
1,040 |
$170K |
| D1120 |
Prophylaxis - child |
3,260 |
3,226 |
$144K |
| D0120 |
Periodic oral evaluation - established patient |
4,760 |
4,664 |
$133K |
| D0274 |
Bitewings - four radiographic images |
3,082 |
2,999 |
$107K |
| D1110 |
Prophylaxis - adult |
2,862 |
2,764 |
$101K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,244 |
3,196 |
$90K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,372 |
1,267 |
$56K |
| D0210 |
Intraoral - complete series of radiographic images |
783 |
759 |
$49K |
| D0140 |
Limited oral evaluation - problem focused |
898 |
845 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
395 |
204 |
$26K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
166 |
109 |
$15K |
| D0330 |
Panoramic radiographic image |
215 |
186 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
799 |
768 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
24 |
14 |
$2K |
| D2394 |
|
13 |
12 |
$2K |