| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,469 |
755 |
$69K |
| D1110 |
Prophylaxis - adult |
2,194 |
2,021 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
2,273 |
2,107 |
$33K |
| D0330 |
Panoramic radiographic image |
801 |
727 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,811 |
1,673 |
$31K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
360 |
216 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
758 |
692 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
394 |
208 |
$17K |
| D2394 |
|
236 |
159 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
225 |
92 |
$8K |
| D1120 |
Prophylaxis - child |
301 |
285 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
97 |
68 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
353 |
329 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
351 |
326 |
$5K |
| D2335 |
|
68 |
37 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
945 |
839 |
$3K |
| D2160 |
|
35 |
29 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
267 |
99 |
$915.00 |
| D0272 |
Bitewings - two radiographic images |
87 |
83 |
$870.00 |