| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,971 |
781 |
$120K |
| D1110 |
Prophylaxis - adult |
3,016 |
2,921 |
$115K |
| D0120 |
Periodic oral evaluation - established patient |
4,193 |
4,109 |
$98K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,749 |
4,627 |
$92K |
| D1120 |
Prophylaxis - child |
2,082 |
2,043 |
$66K |
| D0274 |
Bitewings - four radiographic images |
2,551 |
2,470 |
$63K |
| D0330 |
Panoramic radiographic image |
1,206 |
1,163 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
470 |
290 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
539 |
519 |
$15K |
| D0272 |
Bitewings - two radiographic images |
638 |
629 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
252 |
242 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
68 |
43 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
308 |
292 |
$4K |