| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
677 |
402 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,398 |
1,375 |
$45K |
| D0274 |
Bitewings - four radiographic images |
1,202 |
1,183 |
$33K |
| D1110 |
Prophylaxis - adult |
686 |
667 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
502 |
489 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,466 |
1,443 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
2,067 |
2,014 |
$22K |
| D1120 |
Prophylaxis - child |
547 |
536 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,542 |
1,451 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
410 |
405 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
124 |
80 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
317 |
307 |
$6K |
| D4341 |
|
45 |
20 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
93 |
66 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
15 |
12 |
$974.79 |