| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
226 |
167 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
637 |
608 |
$15K |
| D1120 |
Prophylaxis - child |
263 |
250 |
$11K |
| D1110 |
Prophylaxis - adult |
387 |
374 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
293 |
282 |
$8K |
| D0274 |
Bitewings - four radiographic images |
232 |
225 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
56 |
34 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
43 |
43 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
173 |
164 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
15 |
14 |
$860.02 |
| D1208 |
Topical application of fluoride, excluding varnish |
30 |
29 |
$782.42 |