| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,776 |
1,311 |
$146K |
| D1110 |
Prophylaxis - adult |
2,656 |
2,634 |
$135K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
912 |
651 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
2,013 |
1,991 |
$52K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
510 |
402 |
$49K |
| D0330 |
Panoramic radiographic image |
955 |
948 |
$30K |
| D0274 |
Bitewings - four radiographic images |
896 |
891 |
$23K |
| D1120 |
Prophylaxis - child |
459 |
457 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
451 |
447 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
726 |
706 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
109 |
50 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
358 |
358 |
$5K |
| D2332 |
|
36 |
26 |
$4K |
| D2331 |
|
44 |
36 |
$3K |
| D2330 |
|
40 |
26 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
204 |
199 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
64 |
63 |
$1K |
| D2394 |
|
12 |
12 |
$1K |