| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
322 |
135 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
1,108 |
1,003 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
2,835 |
2,635 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,178 |
1,149 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
519 |
503 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
213 |
95 |
$9K |
| D1120 |
Prophylaxis - child |
411 |
395 |
$8K |
| D1110 |
Prophylaxis - adult |
357 |
341 |
$6K |
| D0274 |
Bitewings - four radiographic images |
484 |
468 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,065 |
1,000 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
373 |
363 |
$4K |
| D0272 |
Bitewings - two radiographic images |
316 |
305 |
$4K |
| D1351 |
Sealant - per tooth |
152 |
42 |
$2K |
| D2950 |
|
46 |
28 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
29 |
14 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
55 |
36 |
$1K |