| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
997 |
525 |
$104K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,496 |
1,433 |
$62K |
| D1110 |
Prophylaxis - adult |
1,239 |
1,196 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
1,219 |
1,179 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
377 |
363 |
$26K |
| D1120 |
Prophylaxis - child |
905 |
883 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
156 |
98 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,178 |
1,135 |
$17K |
| D1206 |
Topical application of fluoride varnish |
869 |
837 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,074 |
844 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
331 |
307 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
654 |
640 |
$11K |
| D0274 |
Bitewings - four radiographic images |
269 |
258 |
$8K |
| D0330 |
Panoramic radiographic image |
124 |
124 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
69 |
38 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
90 |
56 |
$7K |
| D0272 |
Bitewings - two radiographic images |
137 |
133 |
$3K |