| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,344 |
570 |
$86K |
| D1120 |
Prophylaxis - child |
3,128 |
2,947 |
$84K |
| D0120 |
Periodic oral evaluation - established patient |
4,084 |
3,860 |
$77K |
| D1206 |
Topical application of fluoride varnish |
3,539 |
3,340 |
$55K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
811 |
386 |
$48K |
| D1110 |
Prophylaxis - adult |
1,234 |
1,180 |
$45K |
| D0272 |
Bitewings - two radiographic images |
1,324 |
1,251 |
$24K |
| D0274 |
Bitewings - four radiographic images |
493 |
477 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
157 |
65 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
279 |
271 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
278 |
248 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
566 |
501 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
344 |
91 |
$3K |