| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,726 |
748 |
$124K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,113 |
3,855 |
$104K |
| D0140 |
Limited oral evaluation - problem focused |
4,372 |
3,614 |
$75K |
| D1110 |
Prophylaxis - adult |
1,849 |
1,821 |
$67K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,738 |
2,721 |
$51K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
581 |
401 |
$50K |
| D4355 |
|
588 |
585 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
457 |
296 |
$40K |
| D1120 |
Prophylaxis - child |
1,223 |
1,222 |
$39K |
| D0330 |
Panoramic radiographic image |
913 |
800 |
$37K |
| D0272 |
Bitewings - two radiographic images |
679 |
671 |
$13K |
| D2940 |
|
571 |
275 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
903 |
837 |
$7K |
| D0274 |
Bitewings - four radiographic images |
152 |
151 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
14 |
12 |
$966.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
51 |
31 |
$624.79 |