| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
967 |
767 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
329 |
117 |
$22K |
| D1120 |
Prophylaxis - child |
906 |
708 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
700 |
542 |
$9K |
| D0330 |
Panoramic radiographic image |
210 |
176 |
$9K |
| D1351 |
Sealant - per tooth |
302 |
54 |
$8K |
| D0274 |
Bitewings - four radiographic images |
281 |
215 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
135 |
123 |
$5K |
| D0272 |
Bitewings - two radiographic images |
261 |
173 |
$4K |
| D1206 |
Topical application of fluoride varnish |
182 |
142 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
170 |
156 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
55 |
12 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
76 |
15 |
$2K |