| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
486 |
272 |
$29K |
| D1120 |
Prophylaxis - child |
493 |
471 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
420 |
195 |
$25K |
| D0330 |
Panoramic radiographic image |
371 |
362 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
548 |
514 |
$16K |
| D1110 |
Prophylaxis - adult |
227 |
219 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
651 |
616 |
$10K |
| D9110 |
|
154 |
151 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
135 |
87 |
$6K |
| D0272 |
Bitewings - two radiographic images |
354 |
341 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
192 |
189 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
51 |
30 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
60 |
57 |
$499.96 |