| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,663 |
723 |
$61K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
800 |
408 |
$39K |
| D1110 |
Prophylaxis - adult |
1,175 |
1,016 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
684 |
602 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
1,593 |
1,359 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
691 |
594 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
564 |
313 |
$12K |
| D0274 |
Bitewings - four radiographic images |
673 |
576 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
321 |
126 |
$10K |
| D1206 |
Topical application of fluoride varnish |
1,017 |
852 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
511 |
452 |
$9K |
| D1120 |
Prophylaxis - child |
592 |
505 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,239 |
527 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
995 |
835 |
$6K |
| D0272 |
Bitewings - two radiographic images |
105 |
92 |
$2K |
| D4910 |
|
79 |
66 |
$2K |
| D0330 |
Panoramic radiographic image |
77 |
65 |
$1K |
| D2394 |
|
15 |
12 |
$312.75 |
| D1208 |
Topical application of fluoride, excluding varnish |
78 |
69 |
$179.12 |