| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
766 |
484 |
$56K |
| D1110 |
Prophylaxis - adult |
1,358 |
1,345 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
1,731 |
1,711 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,174 |
1,158 |
$25K |
| D1206 |
Topical application of fluoride varnish |
1,434 |
1,413 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
375 |
262 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
655 |
650 |
$18K |
| D1120 |
Prophylaxis - child |
531 |
525 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
159 |
125 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
225 |
219 |
$6K |
| D0272 |
Bitewings - two radiographic images |
284 |
281 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
126 |
125 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
581 |
545 |
$5K |
| D0330 |
Panoramic radiographic image |
278 |
276 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
79 |
55 |
$4K |
| D2331 |
|
37 |
26 |
$2K |
| D2330 |
|
36 |
27 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
230 |
121 |
$983.91 |
| D4910 |
|
12 |
12 |
$810.60 |
| D0601 |
|
41 |
41 |
$205.00 |