| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
550 |
208 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
927 |
718 |
$31K |
| D1110 |
Prophylaxis - adult |
850 |
739 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
343 |
290 |
$18K |
| D1206 |
Topical application of fluoride varnish |
597 |
537 |
$11K |
| D0274 |
Bitewings - four radiographic images |
287 |
262 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
274 |
238 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
470 |
408 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
466 |
346 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
200 |
182 |
$5K |
| D1120 |
Prophylaxis - child |
52 |
49 |
$2K |