| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,647 |
1,003 |
$163K |
| D1110 |
Prophylaxis - adult |
2,874 |
2,667 |
$104K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,735 |
1,515 |
$66K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
813 |
518 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
2,255 |
2,155 |
$57K |
| D0274 |
Bitewings - four radiographic images |
1,453 |
1,343 |
$42K |
| D0330 |
Panoramic radiographic image |
976 |
884 |
$40K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
310 |
217 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,992 |
1,864 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
831 |
708 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
392 |
158 |
$20K |
| D1120 |
Prophylaxis - child |
569 |
525 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
619 |
456 |
$7K |
| D4341 |
|
24 |
13 |
$2K |
| D2394 |
|
19 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
107 |
97 |
$2K |