| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
310 |
235 |
$44K |
| D1120 |
Prophylaxis - child |
429 |
408 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
514 |
493 |
$22K |
| D1206 |
Topical application of fluoride varnish |
584 |
563 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
717 |
678 |
$18K |
| D1110 |
Prophylaxis - adult |
180 |
180 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
76 |
43 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
404 |
401 |
$9K |
| D0272 |
Bitewings - two radiographic images |
201 |
201 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
51 |
31 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
111 |
104 |
$6K |
| D0274 |
Bitewings - four radiographic images |
116 |
116 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
75 |
75 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
115 |
82 |
$3K |