| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
687 |
349 |
$50K |
| D0210 |
Intraoral - complete series of radiographic images |
849 |
845 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,659 |
1,641 |
$35K |
| D1110 |
Prophylaxis - adult |
1,061 |
1,055 |
$34K |
| D1206 |
Topical application of fluoride varnish |
1,096 |
1,082 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
1,073 |
1,068 |
$23K |
| D1120 |
Prophylaxis - child |
654 |
647 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
532 |
520 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
126 |
80 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,745 |
1,707 |
$10K |
| D0274 |
Bitewings - four radiographic images |
487 |
483 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
66 |
39 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
672 |
545 |
$3K |
| D1351 |
Sealant - per tooth |
155 |
24 |
$3K |
| D1999 |
|
138 |
122 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
33 |
12 |
$1K |