| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
928 |
599 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
2,590 |
2,513 |
$56K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,023 |
588 |
$49K |
| D1120 |
Prophylaxis - child |
1,819 |
1,751 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,841 |
2,743 |
$29K |
| D1110 |
Prophylaxis - adult |
1,076 |
1,045 |
$26K |
| D0330 |
Panoramic radiographic image |
747 |
719 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,528 |
1,480 |
$20K |
| D1351 |
Sealant - per tooth |
1,029 |
233 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
305 |
278 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
127 |
122 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
51 |
44 |
$3K |
| D2331 |
|
32 |
14 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
78 |
60 |
$596.66 |