| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
346 |
214 |
$25K |
| D1110 |
Prophylaxis - adult |
629 |
618 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
544 |
416 |
$16K |
| D0274 |
Bitewings - four radiographic images |
551 |
538 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
838 |
827 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
204 |
202 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
485 |
474 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
144 |
80 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
103 |
53 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
256 |
251 |
$7K |
| D1120 |
Prophylaxis - child |
145 |
144 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
100 |
67 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
83 |
14 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
429 |
397 |
$5K |
| D2140 |
|
84 |
55 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
343 |
226 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
12 |
$2K |