| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
673 |
364 |
$52K |
| D1110 |
Prophylaxis - adult |
1,038 |
1,008 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,041 |
1,011 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
1,273 |
1,234 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
1,036 |
963 |
$26K |
| D1120 |
Prophylaxis - child |
592 |
575 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
207 |
115 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
423 |
407 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
501 |
483 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,247 |
1,178 |
$13K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
157 |
97 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
963 |
566 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
160 |
152 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
44 |
25 |
$3K |
| D0272 |
Bitewings - two radiographic images |
79 |
78 |
$2K |
| D2160 |
|
22 |
18 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22 |
14 |
$2K |
| D0270 |
|
44 |
44 |
$317.80 |
| D1330 |
|
138 |
138 |
$0.00 |