| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
494 |
346 |
$36K |
| D1120 |
Prophylaxis - child |
827 |
759 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
779 |
713 |
$20K |
| D1351 |
Sealant - per tooth |
373 |
153 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
706 |
646 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
367 |
245 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
626 |
588 |
$13K |
| D0274 |
Bitewings - four radiographic images |
636 |
584 |
$9K |
| D1110 |
Prophylaxis - adult |
278 |
256 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
251 |
233 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
1,120 |
1,031 |
$6K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
19 |
14 |
$5K |
| D2950 |
|
64 |
54 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
946 |
858 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
54 |
41 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
147 |
137 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
12 |
$899.76 |
| D0272 |
Bitewings - two radiographic images |
31 |
31 |
$291.40 |