| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
601 |
304 |
$83K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
533 |
532 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
209 |
123 |
$28K |
| D1110 |
Prophylaxis - adult |
361 |
361 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
120 |
73 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
468 |
467 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
910 |
884 |
$11K |
| D0274 |
Bitewings - four radiographic images |
414 |
414 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
720 |
714 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
162 |
162 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
33 |
25 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
158 |
158 |
$5K |
| D1120 |
Prophylaxis - child |
53 |
53 |
$3K |