| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,162 |
752 |
$137K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,058 |
681 |
$93K |
| D1120 |
Prophylaxis - child |
1,544 |
1,543 |
$61K |
| D0120 |
Periodic oral evaluation - established patient |
2,001 |
1,999 |
$52K |
| D1110 |
Prophylaxis - adult |
919 |
918 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,752 |
1,751 |
$42K |
| D7140 |
Extraction, erupted tooth or exposed root |
439 |
294 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
340 |
339 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
398 |
398 |
$16K |
| D0274 |
Bitewings - four radiographic images |
472 |
471 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
233 |
229 |
$9K |
| D0272 |
Bitewings - two radiographic images |
340 |
340 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
390 |
377 |
$6K |
| D0330 |
Panoramic radiographic image |
58 |
58 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
148 |
101 |
$1K |