| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,916 |
1,637 |
$359K |
| D1120 |
Prophylaxis - child |
4,027 |
4,025 |
$158K |
| D0120 |
Periodic oral evaluation - established patient |
5,920 |
5,917 |
$158K |
| D1110 |
Prophylaxis - adult |
2,748 |
2,747 |
$139K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,360 |
4,359 |
$102K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,086 |
771 |
$101K |
| D0274 |
Bitewings - four radiographic images |
1,702 |
1,700 |
$54K |
| D0272 |
Bitewings - two radiographic images |
1,366 |
1,365 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
1,513 |
1,503 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
131 |
82 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
335 |
334 |
$14K |
| D2710 |
|
17 |
12 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
151 |
151 |
$9K |
| D2740 |
Crown - porcelain/ceramic |
13 |
12 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
206 |
206 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
888 |
555 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
45 |
28 |
$4K |