| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,106 |
459 |
$106K |
| D1110 |
Prophylaxis - adult |
1,559 |
1,469 |
$56K |
| D0140 |
Limited oral evaluation - problem focused |
1,532 |
1,189 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,318 |
1,216 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
2,072 |
1,950 |
$50K |
| D1120 |
Prophylaxis - child |
1,422 |
1,333 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
487 |
247 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
2,118 |
1,921 |
$30K |
| D0274 |
Bitewings - four radiographic images |
1,025 |
941 |
$29K |
| D1206 |
Topical application of fluoride varnish |
1,724 |
1,602 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,145 |
1,575 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
163 |
84 |
$20K |
| D7962 |
|
118 |
116 |
$18K |
| D0330 |
Panoramic radiographic image |
259 |
243 |
$13K |
| D7961 |
|
45 |
45 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
87 |
27 |
$6K |
| D0272 |
Bitewings - two radiographic images |
308 |
293 |
$5K |
| D4355 |
|
44 |
43 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
59 |
55 |
$914.74 |