| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
296 |
167 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
819 |
614 |
$32K |
| D1120 |
Prophylaxis - child |
652 |
487 |
$31K |
| D1206 |
Topical application of fluoride varnish |
957 |
716 |
$29K |
| D0274 |
Bitewings - four radiographic images |
308 |
229 |
$15K |
| D0272 |
Bitewings - two radiographic images |
421 |
312 |
$15K |
| D0330 |
Panoramic radiographic image |
131 |
114 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
289 |
230 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
111 |
59 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
140 |
99 |
$9K |
| D1110 |
Prophylaxis - adult |
122 |
76 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
110 |
45 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
58 |
40 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
38 |
17 |
$3K |
| D1351 |
Sealant - per tooth |
51 |
12 |
$1K |
| D0270 |
|
15 |
13 |
$295.00 |