| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
454 |
301 |
$41K |
| D1110 |
Prophylaxis - adult |
1,328 |
1,295 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
991 |
964 |
$20K |
| D0330 |
Panoramic radiographic image |
511 |
494 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
214 |
102 |
$16K |
| D0274 |
Bitewings - four radiographic images |
1,249 |
1,220 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
602 |
586 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
773 |
757 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,633 |
1,562 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
78 |
56 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
61 |
44 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,037 |
912 |
$4K |