| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,133 |
1,577 |
$350K |
| D1120 |
Prophylaxis - child |
5,645 |
4,706 |
$213K |
| D0120 |
Periodic oral evaluation - established patient |
6,850 |
5,755 |
$168K |
| D1206 |
Topical application of fluoride varnish |
7,471 |
6,283 |
$156K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,453 |
654 |
$130K |
| D1110 |
Prophylaxis - adult |
2,450 |
2,099 |
$119K |
| D0274 |
Bitewings - four radiographic images |
1,383 |
1,179 |
$49K |
| D0272 |
Bitewings - two radiographic images |
1,812 |
1,543 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
557 |
448 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
423 |
353 |
$15K |
| D0330 |
Panoramic radiographic image |
67 |
58 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
115 |
104 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
12 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
13 |
12 |
$1K |