| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
581 |
360 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,200 |
1,198 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,246 |
1,242 |
$36K |
| D1120 |
Prophylaxis - child |
1,109 |
1,107 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,530 |
1,529 |
$27K |
| D1110 |
Prophylaxis - adult |
568 |
567 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,816 |
1,789 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,484 |
1,462 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
555 |
554 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
408 |
392 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
81 |
55 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
68 |
67 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
55 |
36 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
24 |
13 |
$2K |
| D1206 |
Topical application of fluoride varnish |
35 |
35 |
$620.27 |
| D0272 |
Bitewings - two radiographic images |
17 |
17 |
$337.87 |