| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
386 |
152 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
585 |
562 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
631 |
611 |
$12K |
| D1110 |
Prophylaxis - adult |
376 |
364 |
$12K |
| D2140 |
|
203 |
81 |
$11K |
| D1120 |
Prophylaxis - child |
255 |
248 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
191 |
187 |
$10K |
| D0274 |
Bitewings - four radiographic images |
274 |
261 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
74 |
38 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
29 |
14 |
$3K |
| D2330 |
|
32 |
19 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
101 |
83 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
99 |
50 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$412.80 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$332.72 |