| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,252 |
537 |
$66K |
| D0210 |
Intraoral - complete series of radiographic images |
637 |
623 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,428 |
1,391 |
$37K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
344 |
207 |
$22K |
| D1120 |
Prophylaxis - child |
841 |
784 |
$17K |
| D0330 |
Panoramic radiographic image |
339 |
338 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
193 |
97 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
462 |
446 |
$8K |
| D1206 |
Topical application of fluoride varnish |
443 |
440 |
$7K |
| D1110 |
Prophylaxis - adult |
133 |
119 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
230 |
206 |
$3K |
| D1351 |
Sealant - per tooth |
153 |
41 |
$3K |
| D2335 |
|
33 |
12 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
50 |
12 |
$3K |
| D0274 |
Bitewings - four radiographic images |
143 |
139 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
26 |
15 |
$1K |
| D0272 |
Bitewings - two radiographic images |
141 |
141 |
$1K |
| D2394 |
|
14 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
12 |
12 |
$60.00 |