| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,305 |
890 |
$163K |
| D1110 |
Prophylaxis - adult |
2,034 |
2,012 |
$104K |
| D0120 |
Periodic oral evaluation - established patient |
3,670 |
3,612 |
$98K |
| D1120 |
Prophylaxis - child |
1,953 |
1,940 |
$76K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
762 |
532 |
$73K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,333 |
2,290 |
$54K |
| D0274 |
Bitewings - four radiographic images |
1,028 |
1,026 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
666 |
649 |
$30K |
| D0330 |
Panoramic radiographic image |
223 |
223 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
197 |
197 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
213 |
211 |
$8K |
| D0272 |
Bitewings - two radiographic images |
405 |
393 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
334 |
329 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
22 |
15 |
$2K |
| D1206 |
Topical application of fluoride varnish |
42 |
41 |
$960.61 |
| D0230 |
Intraoral - periapical each additional radiographic image |
68 |
38 |
$640.87 |