| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,096 |
714 |
$85K |
| D1120 |
Prophylaxis - child |
2,127 |
1,942 |
$55K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,499 |
3,192 |
$47K |
| D0240 |
|
2,812 |
1,350 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
2,699 |
2,474 |
$46K |
| D0330 |
Panoramic radiographic image |
1,002 |
904 |
$43K |
| D1110 |
Prophylaxis - adult |
970 |
887 |
$32K |
| D0272 |
Bitewings - two radiographic images |
1,545 |
1,458 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
319 |
248 |
$21K |
| D0274 |
Bitewings - four radiographic images |
695 |
668 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
662 |
595 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
88 |
72 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
204 |
198 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
58 |
38 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
267 |
259 |
$3K |
| D1351 |
Sealant - per tooth |
72 |
16 |
$1K |
| D1999 |
|
108 |
102 |
$1K |