| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,041 |
1,213 |
$210K |
| D1110 |
Prophylaxis - adult |
3,417 |
3,213 |
$121K |
| D0120 |
Periodic oral evaluation - established patient |
4,905 |
4,635 |
$119K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,204 |
737 |
$92K |
| D0220 |
Intraoral - periapical first radiographic image |
3,445 |
3,218 |
$50K |
| D1120 |
Prophylaxis - child |
1,793 |
1,735 |
$48K |
| D0274 |
Bitewings - four radiographic images |
1,302 |
1,208 |
$39K |
| D1206 |
Topical application of fluoride varnish |
2,423 |
2,265 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,044 |
2,422 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
709 |
651 |
$27K |
| D0330 |
Panoramic radiographic image |
334 |
314 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
650 |
643 |
$10K |
| D0272 |
Bitewings - two radiographic images |
481 |
471 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
218 |
208 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
139 |
53 |
$7K |
| D2331 |
|
56 |
39 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
12 |
$2K |