| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
712 |
358 |
$62K |
| D1110 |
Prophylaxis - adult |
952 |
939 |
$35K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
200 |
105 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
742 |
738 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
267 |
256 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,137 |
1,025 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
325 |
319 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
131 |
65 |
$8K |
| D0274 |
Bitewings - four radiographic images |
297 |
289 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,392 |
531 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
188 |
173 |
$5K |
| D4341 |
|
31 |
14 |
$4K |
| D0180 |
|
12 |
12 |
$523.92 |