| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
309 |
203 |
$21K |
| D0210 |
Intraoral - complete series of radiographic images |
468 |
468 |
$21K |
| D1110 |
Prophylaxis - adult |
438 |
437 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
786 |
786 |
$19K |
| D1120 |
Prophylaxis - child |
344 |
344 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
280 |
280 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
110 |
67 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
205 |
205 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
84 |
83 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
57 |
38 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
509 |
509 |
$3K |
| D0274 |
Bitewings - four radiographic images |
200 |
200 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
339 |
338 |
$1K |