| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,049 |
515 |
$137K |
| D1110 |
Prophylaxis - adult |
1,718 |
1,700 |
$108K |
| D0120 |
Periodic oral evaluation - established patient |
2,920 |
2,878 |
$86K |
| D1120 |
Prophylaxis - child |
1,702 |
1,680 |
$72K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,529 |
2,490 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
638 |
627 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,399 |
1,377 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
307 |
173 |
$31K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
157 |
102 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
336 |
326 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
505 |
476 |
$5K |
| D0330 |
Panoramic radiographic image |
58 |
58 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
17 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
129 |
124 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
17 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14 |
14 |
$131.20 |