| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,817 |
685 |
$189K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,673 |
508 |
$133K |
| D1110 |
Prophylaxis - adult |
1,458 |
1,418 |
$89K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,325 |
1,278 |
$68K |
| D0274 |
Bitewings - four radiographic images |
1,649 |
1,618 |
$68K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,607 |
1,583 |
$47K |
| D0210 |
Intraoral - complete series of radiographic images |
523 |
499 |
$40K |
| D7140 |
Extraction, erupted tooth or exposed root |
380 |
142 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
1,747 |
1,697 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
1,134 |
1,118 |
$31K |
| D1120 |
Prophylaxis - child |
618 |
607 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,720 |
1,658 |
$25K |
| D4210 |
|
78 |
36 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
403 |
379 |
$18K |