| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2394 |
|
808 |
663 |
$78K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,283 |
970 |
$60K |
| D2331 |
|
960 |
818 |
$54K |
| D1110 |
Prophylaxis - adult |
1,244 |
1,243 |
$52K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
815 |
667 |
$46K |
| D2332 |
|
1,058 |
883 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
1,532 |
1,531 |
$33K |
| D0274 |
Bitewings - four radiographic images |
703 |
703 |
$15K |
| D2335 |
|
126 |
100 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
948 |
934 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
747 |
744 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
295 |
295 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
14 |
14 |
$1K |
| D1120 |
Prophylaxis - child |
40 |
40 |
$1K |