| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
181 |
129 |
$29K |
| D1120 |
Prophylaxis - child |
521 |
492 |
$26K |
| D1206 |
Topical application of fluoride varnish |
768 |
728 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
506 |
475 |
$19K |
| D1110 |
Prophylaxis - adult |
271 |
260 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
118 |
84 |
$14K |
| D0272 |
Bitewings - two radiographic images |
301 |
280 |
$10K |
| D0274 |
Bitewings - four radiographic images |
172 |
170 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
66 |
63 |
$4K |
| D0330 |
Panoramic radiographic image |
43 |
43 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
64 |
64 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
16 |
12 |
$1K |