| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,493 |
1,660 |
$381K |
| D2335 |
|
2,062 |
829 |
$204K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,344 |
1,064 |
$124K |
| D1110 |
Prophylaxis - adult |
2,359 |
2,299 |
$84K |
| D0120 |
Periodic oral evaluation - established patient |
2,669 |
2,609 |
$48K |
| D0330 |
Panoramic radiographic image |
683 |
667 |
$32K |
| D0272 |
Bitewings - two radiographic images |
2,222 |
2,167 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,275 |
1,256 |
$20K |
| D1120 |
Prophylaxis - child |
635 |
625 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
454 |
440 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
156 |
110 |
$10K |
| D2330 |
|
176 |
78 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
69 |
41 |
$4K |
| D2394 |
|
23 |
13 |
$1K |