| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,162 |
688 |
$97K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
826 |
523 |
$84K |
| D1110 |
Prophylaxis - adult |
1,614 |
1,524 |
$82K |
| D0140 |
Limited oral evaluation - problem focused |
2,119 |
2,014 |
$80K |
| D0210 |
Intraoral - complete series of radiographic images |
1,475 |
1,180 |
$79K |
| D0120 |
Periodic oral evaluation - established patient |
1,489 |
1,424 |
$37K |
| D0330 |
Panoramic radiographic image |
641 |
602 |
$31K |
| D0274 |
Bitewings - four radiographic images |
826 |
786 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
427 |
255 |
$28K |
| D2394 |
|
217 |
148 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
635 |
606 |
$25K |
| D2335 |
|
123 |
67 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,367 |
1,278 |
$15K |
| D2332 |
|
66 |
42 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
817 |
416 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
63 |
38 |
$6K |
| D1206 |
Topical application of fluoride varnish |
270 |
264 |
$6K |
| D1120 |
Prophylaxis - child |
12 |
12 |
$379.50 |