| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,157 |
475 |
$59K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
725 |
295 |
$29K |
| D1110 |
Prophylaxis - adult |
1,060 |
1,018 |
$26K |
| D0274 |
Bitewings - four radiographic images |
1,396 |
1,343 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,629 |
1,570 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
934 |
894 |
$18K |
| D0330 |
Panoramic radiographic image |
492 |
464 |
$18K |
| D1120 |
Prophylaxis - child |
754 |
722 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
1,076 |
1,037 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
242 |
236 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
507 |
480 |
$9K |
| D4355 |
|
69 |
66 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
208 |
201 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
22 |
14 |
$1K |
| D0272 |
Bitewings - two radiographic images |
83 |
80 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
33 |
14 |
$1K |