| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,551 |
561 |
$132K |
| D8670 |
Periodic orthodontic treatment visit |
1,217 |
1,002 |
$109K |
| D1120 |
Prophylaxis - child |
3,214 |
2,579 |
$76K |
| D0120 |
Periodic oral evaluation - established patient |
1,445 |
1,295 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,469 |
995 |
$36K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
237 |
121 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,206 |
1,083 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
472 |
332 |
$14K |
| D0274 |
Bitewings - four radiographic images |
670 |
499 |
$12K |
| D0272 |
Bitewings - two radiographic images |
858 |
629 |
$11K |
| D1206 |
Topical application of fluoride varnish |
701 |
505 |
$10K |
| D0330 |
Panoramic radiographic image |
333 |
240 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
120 |
55 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
390 |
266 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
26 |
13 |
$2K |
| D1351 |
Sealant - per tooth |
46 |
12 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
12 |
$917.70 |