| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,164 |
780 |
$88K |
| D1110 |
Prophylaxis - adult |
2,407 |
2,358 |
$84K |
| D0120 |
Periodic oral evaluation - established patient |
2,782 |
2,727 |
$66K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,061 |
605 |
$60K |
| D0210 |
Intraoral - complete series of radiographic images |
982 |
975 |
$54K |
| D0274 |
Bitewings - four radiographic images |
1,579 |
1,544 |
$52K |
| D1120 |
Prophylaxis - child |
1,145 |
1,141 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,012 |
995 |
$44K |
| D0140 |
Limited oral evaluation - problem focused |
1,880 |
1,775 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,016 |
1,011 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
1,364 |
1,318 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
88 |
40 |
$5K |
| D0330 |
Panoramic radiographic image |
29 |
29 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
15 |
$2K |